Provider Demographics
NPI:1700191137
Name:EN SOLEIL PHARMACY INC
Entity Type:Organization
Organization Name:EN SOLEIL PHARMACY INC
Other - Org Name:EN SOLEIL PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MS PHAR
Authorized Official - Phone:805-460-9600
Mailing Address - Street 1:1673 CORAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-460-9600
Mailing Address - Fax:805-460-9699
Practice Address - Street 1:5735 EL CAMINO REAL
Practice Address - Street 2:SUITE H
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3350
Practice Address - Country:US
Practice Address - Phone:805-460-9600
Practice Address - Fax:805-460-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CA504043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA170019137Medicaid
2127100OtherPK