Provider Demographics
NPI:1144400706
Name:BOIES MEDICAL CENTER PHARMACY INC
Entity Type:Organization
Organization Name:BOIES MEDICAL CENTER PHARMACY INC
Other - Org Name:OPTIMAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAREQ
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:AL MUGHAZZEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:650-743-3235
Mailing Address - Street 1:6110 FAIR OAKS BLVD.
Mailing Address - Street 2:STE #E
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4873
Mailing Address - Country:US
Mailing Address - Phone:916-978-0856
Mailing Address - Fax:877-914-2220
Practice Address - Street 1:6110 FAIR OAKS BLVD
Practice Address - Street 2:STE #E
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4872
Practice Address - Country:US
Practice Address - Phone:916-978-0866
Practice Address - Fax:877-914-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336L0003X
CA525383336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128945OtherPK
CA1144400706Medicaid