Provider Demographics
NPI:1801983101
Name:PHARMACYWORX INC
Entity type:Organization
Organization Name:PHARMACYWORX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABROSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-646-7272
Mailing Address - Street 1:202 E OJAI AVE
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2737
Mailing Address - Country:US
Mailing Address - Phone:805-646-7272
Mailing Address - Fax:805-646-1614
Practice Address - Street 1:202 E OJAI AVE
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2737
Practice Address - Country:US
Practice Address - Phone:805-646-7272
Practice Address - Fax:805-646-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336C0003X
CA502553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801983101Medicaid
2125021OtherPK