Organization
SOUTHGATE ROSE PHARMACY INC
Active
Other names
BLUEROSE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSSMARI R RAMOS-ZAMORA (CEO)
(714) 953-6861
Entity
Organization
Contact information
Practice address
8615 KNOTT AVE, SUITE #7, BUENA PARK, CA 90620-3841
(714) 952-4978
(714) 952-4978
Mailing address
8615 KNOTT AVE, SUITE #7, BUENA PARK, CA 90620-3841
(714) 952-4978
(714) 952-4978
Taxonomy
Speciality
Code
Description
License number
State
261QA0005X
Ambulatory Family Planning Facility
Primary
PHY47605
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY47605
PHARMACY PERMIT
CA
Enumeration date
10/31/2006
Last updated
08/22/2020
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