Provider Demographics
NPI:1871002485
Name:PACIFIC PHARMACY GROUP DBA PACIFIC LTC PHARMACY
Entity Type:Organization
Organization Name:PACIFIC PHARMACY GROUP DBA PACIFIC LTC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-674-3276
Mailing Address - Street 1:361 HOSPITAL RD STE 425
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3525
Mailing Address - Country:US
Mailing Address - Phone:949-524-3566
Mailing Address - Fax:
Practice Address - Street 1:361 HOSPITAL RD STE 425
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3525
Practice Address - Country:US
Practice Address - Phone:949-524-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy