Provider Demographics
NPI:1922154491
Name:C&A PHARMACEUTICAL ENTERPRISES-CA LLC
Entity Type:Organization
Organization Name:C&A PHARMACEUTICAL ENTERPRISES-CA LLC
Other - Org Name:SOUTH COAST MISSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-310-1641
Mailing Address - Street 1:31852 PACIFIC COAST HWY
Mailing Address - Street 2:STE 103
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651
Mailing Address - Country:US
Mailing Address - Phone:949-499-0885
Mailing Address - Fax:949-499-3645
Practice Address - Street 1:31852 PACIFIC COAST HWY
Practice Address - Street 2:STE 103
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:949-499-0885
Practice Address - Fax:949-499-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X
CAPHY53370333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155652OtherPK