Hesperia la Salle Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

License

PHY 43984 Issued in CA

Legal business name

HESPERIA LA SALLE PHARMACY

Practice address

16455 Main St
#8
Hesperia, CA 92345

Phone

(760) 956-2270

Fax

(760) 956-7093

NPI assigned

Dec 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Young S Kim

Title

Owner RPH

Phone

(760) 956-2270

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283212800000",
    "number": "1205997947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16455 MAIN ST",
            "address_2": "#8",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "92345",
            "telephone_number": "760-956-2270",
            "fax_number": "760-956-7093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16455 MAIN ST",
            "address_2": "#8",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "92345",
            "telephone_number": "760-956-2270",
            "fax_number": "760-956-7093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HESPERIA LA SALLE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2010-08-31",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER RPH",
        "authorized_official_telephone_number": "760-956-2270",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY 43984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA439850",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.