Provider Demographics
NPI:1083635049
Name:COMMUNITY PRESCRIPTION CENTER
Entity Type:Organization
Organization Name:COMMUNITY PRESCRIPTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTISON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:619-295-6688
Mailing Address - Street 1:67802 E PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:67802 E PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5457
Practice Address - Country:US
Practice Address - Phone:760-770-4746
Practice Address - Fax:760-770-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY47389333600000X
3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5617331OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA473890Medicaid
5617331OtherOTHER ID NUMBER-COMMERCIAL NUMBER