Organization
GOODLIFE RX LLC
Active
Other names
GARCIA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THUY MIEN LE (MANAGING MEMBER)
(408) 294-3219
Entity
Organization
Contact information
Practice address
25 N 14TH STREET, STE 110, SAN JOSE, CA 95112-6208
(408) 294-3219
(408) 294-3238
Mailing address
25 N 14TH STREET, STE 110, SAN JOSE, CA 95112-6208
(408) 294-3219
(408) 294-3238
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY55477
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-21092
NCPDP NUMBER
CA
01
—
1205869674
MEDI-CAL PROVIDER NUMBER
CA
01
—
PHY55477
BOARD OF PHARMACY PERMIT
CA
Enumeration date
07/09/2006
Last updated
12/08/2020
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