Provider Demographics
NPI:1841395761
Name:MISSION PHARMACY & COMPOUNDING, LTD
Entity Type:Organization
Organization Name:MISSION PHARMACY & COMPOUNDING, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-467-0929
Mailing Address - Street 1:6020 SANTO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1195
Mailing Address - Country:US
Mailing Address - Phone:858-467-0929
Mailing Address - Fax:858-467-0922
Practice Address - Street 1:6020 SANTO RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1195
Practice Address - Country:US
Practice Address - Phone:858-467-0929
Practice Address - Fax:858-467-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY465603336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY46560OtherRX LICENSE
CAPHA447320Medicaid
CA0555980OtherNCPDP