Provider Demographics
NPI:1992861595
Name:REAL WORLD ENTERPRISES
Entity Type:Organization
Organization Name:REAL WORLD ENTERPRISES
Other - Org Name:SMART PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-668-3350
Mailing Address - Street 1:13220 EVENING CREEK DR S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4103
Mailing Address - Country:US
Mailing Address - Phone:858-668-3350
Mailing Address - Fax:858-668-3352
Practice Address - Street 1:13220 EVENING CREEK DR S
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4103
Practice Address - Country:US
Practice Address - Phone:858-668-3350
Practice Address - Fax:858-668-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY468373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA468370Medicaid
5613737OtherNCPDP NUMBER