Organization
4TH STREET PHARMACY, INC
Active
Other names
University Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH GRASELA RPH (OWNER/PIC)
(619) 683-2005
Entity
Organization
Contact information
Practice address
1765 4TH AVE, SAN DIEGO, CA 92101-2670
(619) 398-1800
(619) 481-3733
Mailing address
1765 4TH AVE, SAN DIEGO, CA 92101-2670
(619) 398-1800
(619) 481-3733
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
50831
CA
Other
Enumeration date
06/21/2012
Last updated
06/21/2012
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