San Diego Community Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SAN DIEGO COMMUNITY PHARMACY

Practice address

3703 Camino del Rio S Ste 215B
San Diego, CA 92108-4032

Phone

(619) 249-8623

NPI assigned

Oct 29, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Ollen Williams Jr.

Title

Partner

Phone

(619) 249-8623

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351468800000",
    "number": "1164776191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3703 CAMINO DEL RIO S STE 215B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084032",
            "telephone_number": "619-249-8623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3703 CAMINO DEL RIO S STE 215B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084032",
            "telephone_number": "619-249-8623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO COMMUNITY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-29",
        "last_updated": "2012-10-29",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "OLLEN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "619-249-8623",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA BOARD OF EQUALIZATION - SELLERS PERMIT",
            "identifier": "102302979",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA SECRETARY OF STATE",
            "identifier": "20129010027",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in San Diego, CA
• Providers in San Diego, 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 29, 2012; 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.