Provider Demographics
NPI:1720046709
Name:SENIOR CARE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:SENIOR CARE PHARMACY SERVICES INC
Other - Org Name:SENIOR CARE PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-891-1800
Mailing Address - Street 1:PO BOX 27458
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0115
Mailing Address - Country:US
Mailing Address - Phone:714-891-1800
Mailing Address - Fax:714-891-1102
Practice Address - Street 1:12600 HOOVER ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4100
Practice Address - Country:US
Practice Address - Phone:714-891-1800
Practice Address - Fax:714-891-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY460003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA460000Medicaid
0566919OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4577040001Medicare NSC