NPIMap

Organization Active NPI

Socal Pharmacy LLC

  • Long Term Care Pharmacy
  • Garden Grove, CA
National Provider Identifier
1033744230
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
SOCAL PHARMACY LLC
Doing business as
Grove Harbor Medical Center Pharmacy
Practice address
12555 Garden Grove Blvd Ste 102
Garden Grove, CA 92843-1903
Phone
(714) 636-0593
Fax
(714) 636-7708
NPI assigned
Mar 8, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Seid Amir Farzan Tavakkoli Isfahani, PHARMD
Title
President
Phone
(256) 797-2552

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

12555 Garden Grove Blvd Ste 102
Garden Grove, CA 92843-1903

Mailing address

12555 Garden Grove Blvd Ste 102
Garden Grove, CA 92843-1903
Phone (714) 636-0593

Other identifiers 1

IdentifierTypeStateIssuer
1649713777MedicaidCA

Other names 1

  • Grove Harbor Medical Center Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Socal Pharmacy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1033744230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12555 GARDEN GROVE BLVD STE 102",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431903",
            "telephone_number": "714-636-0593",
            "fax_number": "714-636-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 GARDEN GROVE BLVD STE 102",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431903",
            "telephone_number": "714-636-0593",
            "fax_number": "714-636-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-08",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "TAVAKKOLI ISFAHANI",
        "authorized_official_first_name": "SEID AMIR FARZAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-797-2552",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649713777",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grove Harbor Medical Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grove Harbor Medical Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.