Community Pharmacy
Organization Active NPI Pharmacist · Imperial, CA
NPI 1205948916 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1205948916
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacist 183500000X
- License
- PHY39518 (CA)
- Legal business name
- COMMUNITY PHARMACY
- Practice address
- 117 N Imperial Ave
Imperial, CA 92251-1262 - Phone
- (760) 355-2863
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Noel Carrico
- Title
- Owner Pharmacist
- Phone
- (760) 355-2863
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210428000677 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 6002224250 | Practice locations: Imperial, CA |
National Provider Directory
Locations
127 N Imperial Ave
Imperial, CA 92251
Phone (760) 355-2863
117 N Imperial Ave
Imperial, CA 92251
Phone (760) 355-2863
127 N Imperial Ave
Imperial, CA 92251
Phone (760) 355-2863
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | PHY39518 | CA | Yes |
Addresses
Primary practice location
117 N Imperial Ave
Imperial, CA 92251-1262
Mailing address
PO Box 638
Imperial, CA 92251-0638
Other providers in Imperial, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.