Organization · NPI-2

1918 Winter Street Operating Co LLC

Pharmacy, Community/Retail Pharmacy · San Diego, CA

NPI number1669243762

StatusActive

Last updated in NPPESJul 24, 2024

Details

NPI: 1669243762
Entity type: Organization (NPI-2)
Legal business name: 1918 Winter Street Operating Co LLC
Organization subpart: No
Enumeration date: Jan 9, 2024
Certification date: Jan 8, 2024
Last updated: Jul 24, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
3336C0003X	Pharmacy, Community/Retail Pharmacy	–	–	Yes
332B00000X	Durable Medical Equipment & Medical Supplies	–	–
333600000X	Pharmacy	–	–

Other names

Pavilions Pharmacy #2119 (Doing Business As)

Practice location

3850 Valley Centre Dr
San Diego, CA 92130-2331

Phone 858-793-4667 · Fax 858-793-4431

Mailing address

7 Corporate Dr
Keene, NH 03431-5042

Phone 603-354-7000

Authorized official

Kevin Mcnamara
Authorized Person
6033544619

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