Registry details
Type
Individual
Primary specialty
Pharmacist
Enumerated
Oct 6, 2020
License(s)
P461197790 (WA), 83176 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 51 TIMBERLAND | Aliso Viejo, CA 92656-2108 | 949-616-4551 |
| LOCATION | 51 TIMBERLAND | Aliso Viejo, CA 92656-2108 | 949-616-4551 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.