Provider Demographics
NPI:1245241744
Name:CALIFORNIA PHARMACY SYSTEMS INC
Entity Type:Organization
Organization Name:CALIFORNIA PHARMACY SYSTEMS INC
Other - Org Name:PACIFIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:562-862-8416
Mailing Address - Street 1:11525 BROOKSHIRE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4985
Mailing Address - Country:US
Mailing Address - Phone:562-862-1302
Mailing Address - Fax:562-862-1303
Practice Address - Street 1:11525 BROOKSHIRE AVE
Practice Address - Street 2:STE 100
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4985
Practice Address - Country:US
Practice Address - Phone:562-862-1302
Practice Address - Fax:562-862-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY487833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5601465OtherNCPDP PROVIDER IDENTIFICATION NUMBER