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
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