Organization
IHC SANTA YSABEL PHARMACY
Active
Other names
IHC Santa Ysabel Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT SCHOSTAG (PHARMACY DIRECTOR)
(760) 749-1410
Entity
Organization
Contact information
Practice address
110 1/2 SCHOOL HOUSE CANYON ROAD, SANTA YSABEL, CA 92070
(760) 233-5587
(760) 765-3769
Mailing address
PO BOX 10, SANTA YSABEL, CA 92070-0010
(760) 233-5587
(760) 765-3769
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
PHY46552
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148638
PK
—
Enumeration date
11/17/2014
Last updated
11/17/2014
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