Provider Demographics
NPI:1134265747
Name:MISSION HEALTH CARE PHARMACY CORPORATION
Entity type:Organization
Organization Name:MISSION HEALTH CARE PHARMACY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NISSRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-725-5400
Mailing Address - Street 1:5340 HOLLISTER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2317
Mailing Address - Country:US
Mailing Address - Phone:805-725-5400
Mailing Address - Fax:
Practice Address - Street 1:5340 HOLLISTER AVE STE A
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93111-2317
Practice Address - Country:US
Practice Address - Phone:805-725-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2003030OtherPK
CAPHA229520Medicaid
CAPHA229520Medicaid