Provider Demographics
NPI:1235244260
Name:CALIFORNIA PHARMACY & COMPOUNDING CENTER INC
Entity Type:Organization
Organization Name:CALIFORNIA PHARMACY & COMPOUNDING CENTER INC
Other - Org Name:CALIFORNIA PHARMACY & COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SADAF
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHADORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-642-8057
Mailing Address - Street 1:4000 BIRCH ST
Mailing Address - Street 2:STE 120
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2211
Mailing Address - Country:US
Mailing Address - Phone:949-642-8057
Mailing Address - Fax:949-642-0725
Practice Address - Street 1:4000 BIRCH ST
Practice Address - Street 2:STE 120
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2211
Practice Address - Country:US
Practice Address - Phone:949-642-8057
Practice Address - Fax:949-642-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000765OtherPK
0934330001Medicare NSC