Provider Demographics
NPI:1275835332
Name:FELICITA PHARMACY INC
Entity Type:Organization
Organization Name:FELICITA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GISOO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:760-201-7529
Mailing Address - Street 1:625 W CITRACADO PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6428
Mailing Address - Country:US
Mailing Address - Phone:760-432-8520
Mailing Address - Fax:760-432-8585
Practice Address - Street 1:625 W CITRACADO PKWY STE 106
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-432-8520
Practice Address - Fax:760-432-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504233336C0003X
3336C0004X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA504230Medicaid