Provider Demographics
NPI:1639687585
Name:CEUTICARE LLC
Entity Type:Organization
Organization Name:CEUTICARE LLC
Other - Org Name:REGAL SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:951-817-1005
Mailing Address - Street 1:1875 CALIFORNIA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-6477
Mailing Address - Country:US
Mailing Address - Phone:951-817-1005
Mailing Address - Fax:951-817-1020
Practice Address - Street 1:1875 CALIFORNIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6477
Practice Address - Country:US
Practice Address - Phone:951-817-1005
Practice Address - Fax:951-817-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559353336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57876OtherCALIFORNIA BOARD OF PHARMACY