Provider Demographics
NPI:1306057229
Name:DETENTION'S FACILITY PHARMACY
Entity type:Organization
Organization Name:DETENTION'S FACILITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-974-5962
Mailing Address - Street 1:8525 GIBBS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1758
Mailing Address - Country:US
Mailing Address - Phone:858-974-5977
Mailing Address - Fax:858-974-5827
Practice Address - Street 1:8525 GIBBS DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1758
Practice Address - Country:US
Practice Address - Phone:858-974-5977
Practice Address - Fax:858-974-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABD71401283336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy