Organization
EISENHOWER MEDICAL CENTER
Active
Organization
EISENHOWER MEDICAL CENTER
Active
Other names
EISENHOWER MED CTR OP PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KONZEN PHARM D (PHARMACY MANAGER)
(760) 773-1219
Entity
Organization
Contact information
Practice address
39000 BOB HOPE DR, KIEWIT BLDG, RANCHO MIRAGE, CA 92270-3221
(760) 773-1219
(760) 773-1244
Mailing address
39000 BOB HOPE DR, KIEWIT BLDG, RANCHO MIRAGE, CA 92270-3221
(760) 773-1219
(760) 773-1244
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY35512
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0567771
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHY355120
—
CA
Enumeration date
01/30/2007
Last updated
08/13/2010
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