Provider Demographics
NPI:1609007897
Name:MEDCAB INC
Entity Type:Organization
Organization Name:MEDCAB INC
Other - Org Name:THE MEDICINE CABINET #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ASH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-806-8394
Mailing Address - Street 1:8001 SOMERSET BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4334
Mailing Address - Country:US
Mailing Address - Phone:562-232-0010
Mailing Address - Fax:562-232-0013
Practice Address - Street 1:8001 SOMERSET BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4334
Practice Address - Country:US
Practice Address - Phone:562-232-0010
Practice Address - Fax:562-232-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
CA499363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5635404OtherNCPDP PROVIDER IDENTIFICATION NUMBER