Organization
PATHWAY PHARMACEUTICALS INC
Active
Other names
FIRESIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ADEYEMI OMILANA RPH (OWNER)
(760) 409-4898
Entity
Organization
Contact information
Practice address
73847 HIGHWAY 111, PALM DESERT, CA 92260-4005
(760) 346-1113
(760) 346-8725
Mailing address
73847 HIGHWAY 111, PALM DESERT, CA 92260-4005
(760) 346-1113
(760) 346-8725
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY47407
CA
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2067075
PK
—
05
—
PHA474070
—
CA
Enumeration date
11/15/2006
Last updated
01/19/2017
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