Provider Demographics
NPI:1295056190
Name:GALENIX PHARMACY INC
Entity type:Organization
Organization Name:GALENIX PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:949-713-1010
Mailing Address - Street 1:29851 AVETURA
Mailing Address - Street 2:STE J-1
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:949-713-1010
Mailing Address - Fax:949-713-1012
Practice Address - Street 1:29851 AVETURA
Practice Address - Street 2:STE J-1
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-713-1010
Practice Address - Fax:949-713-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50304333600000X, 3336C0003X
3336S0011X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 50304OtherRETAIL PHARMACY PERMIT