Provider Demographics
NPI:1659826501
Name:HOSPICARE PHARMACY SAN DIEGO
Entity Type:Organization
Organization Name:HOSPICARE PHARMACY SAN DIEGO
Other - Org Name:HOSPICARE PHARMACY SAN DIEGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-434-5350
Mailing Address - Street 1:910 E OHIO AVE
Mailing Address - Street 2:STE 101A
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3438
Mailing Address - Country:US
Mailing Address - Phone:619-434-5350
Mailing Address - Fax:619-434-5359
Practice Address - Street 1:910 E OHIO AVE STE 101A
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3439
Practice Address - Country:US
Practice Address - Phone:619-434-5350
Practice Address - Fax:619-434-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X
CA545223336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163671OtherPK