NPI: 1326152661 · CHULA VISTA, CA 91910 · Pharmacy · NPI assigned 08/17/2006
| Authorized Official | FARIS, KEVIN (CEO) |
| NPI Enumeration Date | 08/17/2006 |
Other providers sharing the same authorized official: FARIS, KEVIN
| Provider | City | State | Total Paid |
|---|---|---|---|
| CUSTOM PRESCRIPTION SHOPPE LLC | FERNDALE | WA | $150K |
| WESTERN PHARMACY GROUP LLC | SAN DIEGO | CA | $385.32 |
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 16 | $60.47 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 90662 | 16 | 16 | $60.47 |