Provider Demographics
NPI:1740345164
Name:CARROL L & DIANE M ATCHLEY OJAI REXALL DRUGS
Entity type:Organization
Organization Name:CARROL L & DIANE M ATCHLEY OJAI REXALL DRUGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ATCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:805-646-4361
Mailing Address - Street 1:1125 MARICOPA HWY
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3126
Mailing Address - Country:US
Mailing Address - Phone:805-646-4361
Mailing Address - Fax:805-646-3116
Practice Address - Street 1:1125 MARICOPA HWY
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3126
Practice Address - Country:US
Practice Address - Phone:805-646-4361
Practice Address - Fax:805-646-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY360803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1989852OtherPK
CAPHA360800Medicaid
1989852OtherPK