Provider Demographics
NPI:1487849246
Name:C & A MEDICAL 1
Entity Type:Organization
Organization Name:C & A MEDICAL 1
Other - Org Name:ADVANCE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARAFSALEH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-489-7077
Mailing Address - Street 1:528 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2720
Mailing Address - Country:US
Mailing Address - Phone:760-489-7077
Mailing Address - Fax:760-489-7040
Practice Address - Street 1:528 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2720
Practice Address - Country:US
Practice Address - Phone:760-489-7077
Practice Address - Fax:760-489-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CAPHY486293336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112589OtherPK
5628005OtherNCPDP PROVIDER IDENTIFICATION NUMBER