Provider Demographics
NPI:1598808271
Name:CAYUCOS PHARMACY
Entity Type:Organization
Organization Name:CAYUCOS PHARMACY
Other - Org Name:CAYUCOS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-995-3538
Mailing Address - Street 1:72 S OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-1646
Mailing Address - Country:US
Mailing Address - Phone:805-995-3538
Mailing Address - Fax:805-995-1273
Practice Address - Street 1:72 S OCEAN AVE
Practice Address - Street 2:
Practice Address - City:CAYUCOS
Practice Address - State:CA
Practice Address - Zip Code:93430-1646
Practice Address - Country:US
Practice Address - Phone:805-995-3538
Practice Address - Fax:805-995-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY-541723336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157397OtherPK
CA1598808271Medicaid
CAPH541720Medicaid