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Organization

WHITE CROSS DRUG STORE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MAX ATIYA (OWNER)
(619) 284-1141
Entity
Organization

Contact information

Practice address
4074 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 284-1141
(619) 284-0503
Mailing address
4074 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336L0003X
Long Term Care Pharmacy
Primary
PHY45196
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0595681
OTHER ID NUMBER
05
PHA451960
CA
Enumeration date
08/10/2006
Last updated
08/31/2007
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