Organization
GOLDEN STATE PHARMACEUTICALS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH JACK AMODEO (PHARMACIST IN CHARGE)
(818) 857-9217
Entity
Organization
Contact information
Practice address
768 CALLE PLANO, CAMARILLO, CA 93012
(818) 857-9217
Mailing address
768 CALLE PLANO, CAMARILLO, CA 93012
(818) 857-9217
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
48647
CA
3336M0002X
Mail Order Pharmacy
48647
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48647
STATE PHARMACY LICENSE
CA
Enumeration date
09/20/2007
Last updated
09/27/2010
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