Provider Demographics
NPI:1396900353
Name:OC PHARMACY
Entity type:Organization
Organization Name:OC PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:OMEED
Authorized Official - Middle Name:
Authorized Official - Last Name:ASKARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-429-5326
Mailing Address - Street 1:31654 RANCHO VIEJO RD
Mailing Address - Street 2:STE N
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2773
Mailing Address - Country:US
Mailing Address - Phone:800-429-5102
Mailing Address - Fax:949-429-2308
Practice Address - Street 1:31654 RANCHO VIEJO RD
Practice Address - Street 2:STE N
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2773
Practice Address - Country:US
Practice Address - Phone:949-429-5326
Practice Address - Fax:949-429-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 332B00000X, 333600000X
CA490853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49085Medicaid
CA1129638Medicaid
2113811OtherPK
2113811OtherPK