Organization
DAVID LOTH
Active
Other names
Park Woods Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID LOTH (OWNER)
(669) 999-6870
Entity
Organization
Contact information
Practice address
1782 W HAMMER LN, STOCKTON, CA 95209-2922
(669) 999-6870
Mailing address
1782 W HAMMER LN, STOCKTON, CA 95209-2922
(669) 999-6870
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY54414
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2163597
PK
—
Enumeration date
08/11/2016
Last updated
09/21/2016
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