Organization
GLACIEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CRISTOBAL CANCHOLA (CEO)
(858) 345-7260
Entity
Organization
Contact information
Practice address
7500 MELBA AVE, WEST HILLS, CA 91304-5361
(858) 345-7260
(619) 938-4785
Mailing address
7500 MELBA AVE, WEST HILLS, CA 91304-5361
(858) 345-7260
(619) 938-4785
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
—
—
Other
Enumeration date
10/30/2016
Last updated
10/30/2016
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