Organization
A FAMILY PHARMACY-HESPERIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS TEKELE PHARMACIST (PRESIDENT)
(760) 242-5452
Entity
Organization
Contact information
Practice address
11919 HESPERIA RD, STE C, HESPERIA, CA 92345-1855
(760) 244-3777
(760) 242-8617
Mailing address
PO BOX 900, VICTORVILLE, CA 92393-0900
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY46638
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5614020
OTHER ID NUMBER
—
Enumeration date
10/12/2006
Last updated
04/15/2008
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