Active NPI
SD Healthcare RX NC
- Community/Retail Pharmacy
- San Diego, CA
National Provider Identifier
1053490797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY371130
- Legal business name
- SD HEALTHCARE RX NC
- Practice address
- 3030 Childrens Way
#108
San Diego, CA 92123-4232 - Phone
- (858) 966-4060
- Fax
- (858) 966-5995
- NPI assigned
- Nov 3, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Paresh Patel
- Title
- Cfo/Director
- Phone
- (858) 966-4060
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHY371130 | CA | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
3030 Childrens Way
#108
San Diego, CA 92123-4232
Mailing address
3030 Childrens Way
#108
San Diego, CA 92123-4232
Phone (858) 966-4060
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHA371130 | Medicaid | CA | |
| 0518867 | Other | NCPDP |
Other names 1
- CHILDRENS COMMUNITY PHARMACY
National Provider Directory
National Provider Directory- Tax ID family
- Rady Children'S Health Services-San Diego
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dental Clinic/Center
- San Diego, CA
- NPI 1649369653
-
- Home Infusion Therapy Pharmacy
- San Diego, CA
- NPI 1699853713
Locations
3030 Childrens Way
Ste 108
San Diego, CA 92123
Phone (858) 966-4060
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731369600000",
"number": "1053490797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3030 CHILDRENS WAY",
"address_2": "#108",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234232",
"telephone_number": "858-966-4060",
"fax_number": "858-966-5995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3030 CHILDRENS WAY",
"address_2": "#108",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234232",
"telephone_number": "858-966-4060",
"fax_number": "858-966-5995"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SD HEALTHCARE RX NC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-03",
"last_updated": "2024-11-12",
"status": "A",
"authorized_official_last_name": "PATEL",
"authorized_official_first_name": "PARESH",
"authorized_official_title_or_position": "CFO/DIRECTOR",
"authorized_official_telephone_number": "858-966-4060"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY371130",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PHA371130",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "0518867",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CHILDRENS COMMUNITY PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.