Individual
BO LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
33975 DATE PALM DR, CATHEDRAL CITY, CA 92234-4736
(760) 202-3533
Mailing address
33975 DATE PALM DR, 92234-4736, CATHEDRAL CITY, CA 92234-4736
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH 65419
CA
Other
Enumeration date
01/27/2012
Last updated
05/04/2012
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