Organization
POWAY PHARMACY LLC
Active
Other names
Poway Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GHOLAM ROUZITALAB PHARM.D. (PHARMACIST IN CHARGE)
(858) 842-4206
Entity
Organization
Contact information
Practice address
14837 POMERADO RD, POWAY, CA 92064-2803
(858) 842-4206
(951) 674-9773
Mailing address
14837 POMERADO RD, POWAY, CA 92064-2803
(858) 842-4206
(858) 842-4257
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
55623
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2170472
PK
—
Enumeration date
08/01/2017
Last updated
03/13/2018
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