Provider Demographics
NPI:1154835973
Name:MAJESTIC PHARMACY INC
Entity Type:Organization
Organization Name:MAJESTIC PHARMACY INC
Other - Org Name:ROSEMONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO/SEC./DIR.
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-462-5025
Mailing Address - Street 1:7283 ENGINEER RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1414
Mailing Address - Country:US
Mailing Address - Phone:858-598-5600
Mailing Address - Fax:858-598-5619
Practice Address - Street 1:7283 ENGINEER RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1414
Practice Address - Country:US
Practice Address - Phone:619-280-1254
Practice Address - Fax:619-280-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558593336C0003X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57982OtherSTATE BOARD OF PHARMACY PERMIT
CA55859OtherSTATE BOARD OF PHARMACY PERMIT