Organization
POWAY PHARMACY LLC
Active
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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