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Organization

BONITA DRIVE THRU PHARMACY

Active
Other names
Bonita Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
DANIEL LEE (CFO)
(619) 434-5350
Entity
Organization

Contact information

Practice address
4190 BONITA RD STE 101, BONITA, CA 91902-1330
(619) 900-6002
(619) 900-6012
Mailing address
4190 BONITA RD STE 101, BONITA, CA 91902-1330
(619) 900-6002
(619) 900-6012

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
53888
CA
3336C0004X
Compounding Pharmacy
3336L0003X
Long Term Care Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2155977
PK
Enumeration date
02/18/2016
Last updated
11/23/2016
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