Provider Demographics
NPI:1649641309
Name:SUPERIOR CARE PHARMACY INC
Entity type:Organization
Organization Name:SUPERIOR CARE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-785-3993
Mailing Address - Street 1:9064 PULSAR CT
Mailing Address - Street 2:SUITE G&H
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-7354
Mailing Address - Country:US
Mailing Address - Phone:619-785-3993
Mailing Address - Fax:844-637-2447
Practice Address - Street 1:9064 PULSAR CT
Practice Address - Street 2:SUITE G&H
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-7354
Practice Address - Country:US
Practice Address - Phone:619-785-3993
Practice Address - Fax:844-637-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY53762333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy