Provider Demographics
NPI:1366762098
Name:NELSON, JOSEPH L (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:NELSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2619
Mailing Address - Country:US
Mailing Address - Phone:619-435-6585
Mailing Address - Fax:619-435-5914
Practice Address - Street 1:836 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2619
Practice Address - Country:US
Practice Address - Phone:619-435-6585
Practice Address - Fax:619-435-5914
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist