Provider Demographics
NPI:1992687909
Name:CHULAVISTA PHARMACY LLC
Entity type:Organization
Organization Name:CHULAVISTA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ATENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:619-781-8177
Mailing Address - Street 1:384 H ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5513
Mailing Address - Country:US
Mailing Address - Phone:619-781-8177
Mailing Address - Fax:619-623-3435
Practice Address - Street 1:384 H ST STE 100
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5513
Practice Address - Country:US
Practice Address - Phone:619-781-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy