Organization
ALVARADO MEDICAL PLAZA PHARMACY
Active
Organization
ALVARADO MEDICAL PLAZA PHARMACY
Active
Other names
Alvarado Medical Plaza Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BILL BURDINE BS (OWNER)
(619) 287-5035
Entity
Organization
Contact information
Practice address
5555 RESERVOIR DR STE 114, SAN DIEGO, CA 92120-5197
(619) 287-5035
(619) 287-5098
Mailing address
5555 RESERVOIR DR STE 114, SAN DIEGO, CA 92120-5197
(619) 287-5035
(619) 287-5098
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY38199
CA
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115610
PK
—
05
—
PHA3204424
—
CA
Enumeration date
05/20/2006
Last updated
12/17/2015
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