| Itc Pharmacy I | |
|
590 S Marine Dr Suite 126 Tamuning GU 96913-3507 | |
| (671) 646-6395 | |
| (671) 646-4332 |
| Full Name | Itc Pharmacy I |
|---|---|
| Speciality | Clinic/center |
| Location | 590 S Marine Dr, Tamuning, Guam |
| Authorized Official Name and Position | Julius Santos Fernando (PHARMACIST) |
| Authorized Official Contact | 6716466395 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Itc Pharmacy I Po Box 11468 Tamuning GU 96931-1468 Ph: (671) 646-6395 | Itc Pharmacy I 590 S Marine Dr Suite 126 Tamuning GU 96913-3507 Ph: (671) 646-6395 |
| NPI Number | 1356330724 |
|---|---|
| Provider Enumeration Date | 10/19/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356330724 | NPI | - | NPPES |
| 631 | Medicaid | GU |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | PCY014 (Guam) | Primary |
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