Organization
NIPOMO PHARMACY INC
Active
Other names
nipomo rexall drugs
Organization subpart
No
Provider details
NPI number
Authorized official
GHOLAM ROUZITALAB (VICE PRESIDENT)
(805) 929-1929
Entity
Organization
Contact information
Practice address
695 W TEFFT ST STE A, NIPOMO, CA 93444-9395
(805) 929-1929
(888) 590-0871
Mailing address
695 W TEFFT ST STE A, NIPOMO, CA 93444-9395
(805) 929-1929
(888) 590-0871
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY50681
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2131346
PK
—
05
—
5641546
—
CA
Enumeration date
07/26/2011
Last updated
03/22/2022
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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