Provider Demographics
NPI:1790890721
Name:MONTECITO RX
Entity Type:Organization
Organization Name:MONTECITO RX
Other - Org Name:SAN YSIDRO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:EDINGTON HOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-969-2284
Mailing Address - Street 1:1498 EAST VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-1241
Mailing Address - Country:US
Mailing Address - Phone:805-969-2284
Mailing Address - Fax:805-565-3174
Practice Address - Street 1:1498 EAST VALLEY RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-1241
Practice Address - Country:US
Practice Address - Phone:805-969-2284
Practice Address - Fax:805-565-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57904OtherBOARD OF PHARMACY