Provider Demographics
NPI:1407968332
Name:HOLY CROSS APOTHECARY INC
Entity Type:Organization
Organization Name:HOLY CROSS APOTHECARY INC
Other - Org Name:HOLY CROSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-898-1628
Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:STE 130
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:818-898-1628
Mailing Address - Fax:818-365-3539
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:STE 130
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1200
Practice Address - Country:US
Practice Address - Phone:818-898-1628
Practice Address - Fax:818-365-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY358103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407968332Medicaid
1997793OtherPK
CAPHA358100Medicaid