Provider Demographics
NPI:1093795577
Name:SPRING PARK PHARMACY INC
Entity Type:Organization
Organization Name:SPRING PARK PHARMACY INC
Other - Org Name:CEDAR PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-758-7650
Mailing Address - Street 1:6226 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1423
Mailing Address - Country:US
Mailing Address - Phone:760-630-8806
Mailing Address - Fax:760-630-2406
Practice Address - Street 1:161 THUNDER DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6016
Practice Address - Country:US
Practice Address - Phone:760-758-7650
Practice Address - Fax:760-758-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127529OtherPK
2127529OtherPK