Provider Demographics
NPI:1598067613
Name:THE CENTER FOR COMPREHENSIVE CARE AND DIAGNOSIS OF INHERITED BLOOD DIS
Entity Type:Organization
Organization Name:THE CENTER FOR COMPREHENSIVE CARE AND DIAGNOSIS OF INHERITED BLOOD DIS
Other - Org Name:CIBD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:657-375-0453
Mailing Address - Street 1:701 S PARKER ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4727
Mailing Address - Country:US
Mailing Address - Phone:949-748-7521
Mailing Address - Fax:949-748-7615
Practice Address - Street 1:701 S PARKER ST STE 1400
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4727
Practice Address - Country:US
Practice Address - Phone:949-748-7521
Practice Address - Fax:949-748-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 333600000X
CAPHY503963336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128920OtherPK