Provider Demographics
NPI:1023296449
Name:DRG PHARMACY LLC
Entity type:Organization
Organization Name:DRG PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-981-1171
Mailing Address - Street 1:401 N LOMBARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8032
Mailing Address - Country:US
Mailing Address - Phone:805-488-8200
Mailing Address - Fax:805-488-8211
Practice Address - Street 1:401 N LOMBARD ST STE A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8032
Practice Address - Country:US
Practice Address - Phone:805-488-8200
Practice Address - Fax:805-488-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537643336C0003X
3336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023296449Medicaid
AZ553516Medicaid
5630478OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI1023296449Medicaid
OH2973859Medicaid
MN1023296449Medicaid
MT1023296449Medicaid
NV1023296449Medicaid
ID1023296449Medicaid
WA6032569Medicaid