Park Compounding, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY53360 Issued in CA

Legal business name

PARK COMPOUNDING, INC.

Practice address

9257 Research Dr
Irvine, CA 92618

Phone

(844) 446-6979

Fax

(949) 551-1950

NPI assigned

Feb 16, 2007

Organization subpart

No

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

Authorized official

Name

Andrew Boll

Title

Secretary & Cfo

Phone

(858) 704-4040

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538352000000",
    "number": "1114061132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12264 EL CAMINO REAL STE 350",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921300001",
            "telephone_number": "858-704-4040",
            "fax_number": "858-345-1745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9257 RESEARCH DR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92618",
            "telephone_number": "844-446-6979",
            "fax_number": "949-551-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK COMPOUNDING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2018-10-01",
        "status": "A",
        "authorized_official_last_name": "BOLL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "SECRETARY & CFO",
        "authorized_official_telephone_number": "858-704-4040"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY53360",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0522967",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob Paredes, D.C.
• Keyur Parikh, PHARMD
• Priya Parikh
• Priya Sunil Parikh
• Parisa Behroozi, D.D.S., Inc.
• Park Place Optometry
• Albert Park, DMD
• Andrew Park, DC, CCSP
• Angela Park, NP
• Annie Park, MAOTRL

• Community/Retail Pharmacy in Irvine, CA
• Providers in Irvine, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; 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.