Provider Demographics
NPI:1275954224
Name:IRX PHARMACY SOUTH INC.
Entity Type:Organization
Organization Name:IRX PHARMACY SOUTH INC.
Other - Org Name:CARMEL VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELANSARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:858-481-4990
Mailing Address - Street 1:12750 CARMEL COUNTRY RD
Mailing Address - Street 2:STE A101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2159
Mailing Address - Country:US
Mailing Address - Phone:858-481-4990
Mailing Address - Fax:858-481-4949
Practice Address - Street 1:12750 CARMEL COUNTRY RD
Practice Address - Street 2:STE A101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2159
Practice Address - Country:US
Practice Address - Phone:858-481-4990
Practice Address - Fax:858-481-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY516443336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy