Organization
GRANDPAS COMPOUNDING PHARMACY INC
Active
Other names
Grandpas Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAN WILLS (MANAGER)
(530) 622-2323
Entity
Organization
Contact information
Practice address
7563 GREEN VALLEY RD, PLACERVILLE, CA 95667-3917
(530) 622-2323
(530) 622-2011
Mailing address
7563 GREEN VALLEY RD, PLACERVILLE, CA 95667-3917
(530) 622-2323
(530) 622-2011
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHY045878
CA
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155454
PK
—
Enumeration date
02/08/2007
Last updated
11/23/2015
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