Provider Demographics
NPI:1649655267
Name:SCRIPPS HEALTH ENCINITAS AMBULATORY PHARMACY
Entity type:Organization
Organization Name:SCRIPPS HEALTH ENCINITAS AMBULATORY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-678-7004
Mailing Address - Street 1:10140 CAMPUS POINT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1520
Mailing Address - Country:US
Mailing Address - Phone:858-678-7111
Mailing Address - Fax:
Practice Address - Street 1:310 SANTA FE DR STE 109
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5124
Practice Address - Country:US
Practice Address - Phone:858-678-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153242OtherPK