Organization
MEDICAL SPECIALTY PHARMACY
Active
Other names
Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY OKAMOTO (PRESIDENT, AO)
(916) 685-5034
Entity
Organization
Contact information
Practice address
18433 ROSCOE BLVD, NORTHRIDGE, CA 91325-4108
(818) 993-7333
(818) 993-7191
Mailing address
C/O NUTRISHARE, 9854 KENT ST, ELK GROVE, CA 95624
(616) 685-5034
(916) 685-5588
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY50945
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136091
PK
—
Enumeration date
08/10/2006
Last updated
08/24/2016
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