Provider Information for 1891982096
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LA VITA COMPOUNDING PHARMACY LLC
Other Names:Doing Business As:LA VITA COMPOUNDING PHARMACYOrganization Subpart: NO
NPI: 1891982096
Last Updated: 2022-11-15
Certification Date: 2022-11-15
Certification Date: 2022-11-15
Details
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NPI | 1891982096 | ||||||||||||||||
Enumeration Date | 2007-10-02 | ||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||
Status | Active | ||||||||||||||||
Authorized Official Information | Name: CHRISTINE GIVANT RPH Title: OWNER Phone: 8584532500 | ||||||||||||||||
Mailing Address | 11468 SORRENTO VALLEY RD STE C SAN DIEGO, CA 92121-1347 United States Phone: 858-453-2500 | Fax:858-453-2501 | ||||||||||||||||
Primary Practice Address | 11468 SORRENTO VALLEY RD STE C SAN DIEGO, CA 92121-1347 United States Phone: 858-453-2500 | Fax:858-453-2501 | ||||||||||||||||
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