Provider Demographics
NPI:1275676330
Name:MISSION PHARMACY INC
Entity Type:Organization
Organization Name:MISSION PHARMACY INC
Other - Org Name:MISSION PHARMACY SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:530-743-5451
Mailing Address - Street 1:400 PLUMAS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-5081
Mailing Address - Country:US
Mailing Address - Phone:530-674-7214
Mailing Address - Fax:530-743-3713
Practice Address - Street 1:400 PLUMAS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5081
Practice Address - Country:US
Practice Address - Phone:530-674-7214
Practice Address - Fax:530-674-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY458063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA458060Medicaid
2001372OtherPK