Organization
SAN DIEGO COMPOUNDING PHARMACY A PROF CORP
Active
Organization
SAN DIEGO COMPOUNDING PHARMACY A PROF CORP
Active
Other names
SAN DIEGO COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME GREENE (OWNER)
(858) 277-8884
Entity
Organization
Contact information
Practice address
5395 RUFFIN RD STE 104, SAN DIEGO, CA 92123-1338
(858) 277-8884
(858) 277-8889
Mailing address
5395 RUFFIN RD STE 104, SAN DIEGO, CA 92123-1338
(858) 277-8884
(858) 277-8889
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY47015
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113433
PK
—
Enumeration date
08/10/2006
Last updated
08/22/2016
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