Provider Demographics
NPI:1598588832
Name:ALVARADO PHARMACY SD
Entity type:Organization
Organization Name:ALVARADO PHARMACY SD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAOUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:619-996-0619
Mailing Address - Street 1:1789 VISTA GRANDE RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3817
Mailing Address - Country:US
Mailing Address - Phone:619-996-0619
Mailing Address - Fax:619-877-0110
Practice Address - Street 1:5555 RESERVOIR DR STE 114
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5197
Practice Address - Country:US
Practice Address - Phone:619-996-0619
Practice Address - Fax:619-877-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy