Organization · NPI-2

4th Street Pharmacy, INC

Pharmacy, Community/Retail Pharmacy · San Diego, CA

NPI number1265795447
StatusActive
Last updated in NPPESJun 21, 2012

Details

NPI
1265795447
Entity type
Organization (NPI-2)
Legal business name
4th Street Pharmacy, INC
Organization subpart
No
Enumeration date
Jun 21, 2012
Last updated
Jun 21, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336C0003X Pharmacy, Community/Retail Pharmacy50831CAYes

Other names

  • University Compounding Pharmacy (Doing Business As)

Practice location

1765 4th Ave
San Diego, CA 92101-2670

Phone 619-398-1800 · Fax 619-481-3733

Mailing address

1765 4th Ave
San Diego, CA 92101-2670

Phone 619-398-1800 · Fax 619-481-3733

Authorized official

Joseph Grasela
Owner/Pic
6196832005

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Pharmacy, Community/Retail Pharmacy providers in San Diego, CA