Provider Demographics
NPI:1619075066
Name:HEALTH PLUS PHARMACY INC.
Entity Type:Organization
Organization Name:HEALTH PLUS PHARMACY INC.
Other - Org Name:CAMBRIA VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-927-4236
Mailing Address - Street 1:2306 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428
Mailing Address - Country:US
Mailing Address - Phone:805-927-4236
Mailing Address - Fax:
Practice Address - Street 1:2306 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428
Practice Address - Country:US
Practice Address - Phone:805-927-4236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH PLUS PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA447120Medicaid