Provider Demographics
NPI:1821242421
Name:ASSURED PHARMACY
Entity Type:Organization
Organization Name:ASSURED PHARMACY
Other - Org Name:ASSURED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-222-9971
Mailing Address - Street 1:17935 SKY PARK CIR
Mailing Address - Street 2:STE F
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2040 PACIFIC COAST HWY
Practice Address - Street 2:STE R
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2660
Practice Address - Country:US
Practice Address - Phone:949-222-9971
Practice Address - Fax:949-271-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 489253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5632698OtherNCPDP PROVIDER IDENTIFICATION NUMBER