Organization
COMMUNITY PHARMACY
Active
Organization
COMMUNITY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY DUNST (MGR)
(805) 524-9461
Entity
Organization
Contact information
Practice address
852 W VENTURA ST, FILLMORE, CA 93015-1837
(805) 524-9461
(805) 542-9451
Mailing address
852 W VENTURA ST, FILLMORE, CA 93015-1837
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY43801
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0507484
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
PHA438010
—
CA
Enumeration date
08/15/2006
Last updated
08/22/2020
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