Provider Demographics
NPI:1831187806
Name:DEL RIO SANITARIUM PHARMACY, INC
Entity type:Organization
Organization Name:DEL RIO SANITARIUM PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC/DIR DEL RIO SAN. PHARMACY INC
Authorized Official - Prefix:
Authorized Official - First Name:MORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-927-6586
Mailing Address - Street 1:7004 E GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-2014
Mailing Address - Country:US
Mailing Address - Phone:562-927-6586
Mailing Address - Fax:
Practice Address - Street 1:7004 E GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-2014
Practice Address - Country:US
Practice Address - Phone:562-927-6586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY8062333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPH0B80620Medicaid
1299120001Medicare ID - Type Unspecified