Provider Demographics
NPI:1639281553
Name:PACIFICA PHARMACY
Entity Type:Organization
Organization Name:PACIFICA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-887-9500
Mailing Address - Street 1:18682 BEACH BLVD
Mailing Address - Street 2:STE 115
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18682 BEACH BLVD
Practice Address - Street 2:STE 115
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2048
Practice Address - Country:US
Practice Address - Phone:714-887-9500
Practice Address - Fax:714-887-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY467153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA467150Medicaid
5614082OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5614082OtherOTHER ID NUMBER
5386510001Medicare NSC