Provider Demographics
NPI:1326365230
Name:SKYLINE RX INC
Entity Type:Organization
Organization Name:SKYLINE RX INC
Other - Org Name:OXNARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:SENG
Authorized Official - Middle Name:KEY
Authorized Official - Last Name:TAING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:805-322-6923
Mailing Address - Street 1:300 S A ST
Mailing Address - Street 2:#100
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5822
Mailing Address - Country:US
Mailing Address - Phone:805-322-6923
Mailing Address - Fax:805-322-6924
Practice Address - Street 1:300 S A ST
Practice Address - Street 2:#100
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5822
Practice Address - Country:US
Practice Address - Phone:805-322-6923
Practice Address - Fax:805-322-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-02
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50294333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50294OtherRETAIL PHARMACY PERMIT