Organization
DEL SUR PHARMACY
Active
Other names
Fairbanks Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD GRAMLICH (CEO)
(858) 759-6625
Entity
Organization
Contact information
Practice address
16089 SAN DIEGUITO RD # H102, RANCHO SANTA FE, CA 92067-9529
(858) 759-6625
(858) 759-6729
Mailing address
PO BOX 9227, RANCHO SANTA FE, CA 92067-4227
(858) 759-6625
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
55594
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176915
PK
—
Enumeration date
04/10/2018
Last updated
04/10/2018
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