Provider Demographics
NPI:1366453953
Name:MEDICINE WORLD INC
Entity Type:Organization
Organization Name:MEDICINE WORLD INC
Other - Org Name:PARK BOULEVARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-295-3109
Mailing Address - Street 1:3904 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3904 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3502
Practice Address - Country:US
Practice Address - Phone:619-295-3109
Practice Address - Fax:619-497-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY45333333600000X
3336C0003X, 3336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Not Answered3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA453330Medicaid
0576821OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA453330Medicaid