Provider Demographics
NPI:1073046280
Name:ALS PHARMACY AND COMPOUNDING CENTER INC
Entity Type:Organization
Organization Name:ALS PHARMACY AND COMPOUNDING CENTER INC
Other - Org Name:HIGHLAND FAIRE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-571-5545
Mailing Address - Street 1:5731 WATT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4751
Mailing Address - Country:US
Mailing Address - Phone:916-571-5545
Mailing Address - Fax:916-571-5548
Practice Address - Street 1:5731 WATT AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-4751
Practice Address - Country:US
Practice Address - Phone:916-571-5545
Practice Address - Fax:916-571-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy