Provider Demographics
NPI:1114948163
Name:SALEH PHARMACY, INC.
Entity Type:Organization
Organization Name:SALEH PHARMACY, INC.
Other - Org Name:WAGNER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO/SEC./DIR.
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-924-6688
Mailing Address - Street 1:1224 EAST MCFADDEN AVE.
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-547-3590
Mailing Address - Fax:714-547-5977
Practice Address - Street 1:1224 EAST MCFADDEN AVE.
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-547-3590
Practice Address - Fax:714-547-5977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY357243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY35724OtherSTATE LICENSE
CA954218320OtherFEDERAL TAX ID #
CA0597596OtherNABP # OR NCPDP #
CAPHA357240Medicaid
CAPHA357240Medicaid