Provider Demographics
NPI:1336285956
Name:ROLLING OAKS PHARMACY INC
Entity Type:Organization
Organization Name:ROLLING OAKS PHARMACY INC
Other - Org Name:ROLLING OAKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES / CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MHA
Authorized Official - Phone:805-557-1006
Mailing Address - Street 1:325 E ROLLING OAKS DR #140A
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1077
Mailing Address - Country:US
Mailing Address - Phone:805-557-1006
Mailing Address - Fax:805-557-1706
Practice Address - Street 1:325 E ROLLING OAKS DR #140A
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1077
Practice Address - Country:US
Practice Address - Phone:805-557-1006
Practice Address - Fax:805-557-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CAPHY469183336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336285956Medicaid
5614424OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHY46918OtherCALIFORNIA PHARMACY LICENSE
MD0244708 00Medicaid
5287740001Medicare PIN
CAPHY46918OtherCALIFORNIA PHARMACY LICENSE