Provider Demographics
NPI:1235516915
Name:DERM CONTACT PLLC
Entity Type:Organization
Organization Name:DERM CONTACT PLLC
Other - Org Name:RANCHO PUEBLO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-834-5303
Mailing Address - Street 1:31515 RANCHO PUEBLO RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-834-5303
Mailing Address - Fax:951-943-4645
Practice Address - Street 1:31515 RANCHO PUEBLO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-834-5303
Practice Address - Fax:951-943-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy