Organization
GOODLIFE RX LLC
Active
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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