Active NPI
Pacific Pharmacy Group
- Community/Retail Pharmacy
- Fallbrook, CA
National Provider Identifier
1235208570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY49043
- Legal business name
- PACIFIC PHARMACY GROUP
- Practice address
- 343 E Alvarado St
Fallbrook, CA 92028-2966 - Phone
- (760) 728-1607
- Fax
- (760) 728-2398
- NPI assigned
- Nov 8, 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
- Jan Balthasar
- Title
- Ceo
- Phone
- (949) 215-5522
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY49043 | CA | Primary |
Addresses
Primary practice location
343 E Alvarado St
Fallbrook, CA 92028-2966
Mailing address
1010 W la Veta Ave
Suite 130
Orange, CA 92868-4300
Phone (949) 215-5522
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992005 | Other | PK | |
| 1235208570 | Medicaid | CA |
Other names 1
- FALLBROOK PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120927000485 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 7113123639 |
4 other NPIs on this enrollment Practice locations: Newhall, CA; Newport Beach, CA; Orange, CA |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
1010 W La Veta Ave
Ste 130
Orange, CA 92868
Phone (714) 550-9798
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1391558400000",
"number": "1235208570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 W LA VETA AVE",
"address_2": "SUITE 130",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684300",
"telephone_number": "949-215-5522",
"fax_number": "949-215-8988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "343 E ALVARADO ST",
"city": "FALLBROOK",
"state": "CA",
"postal_code": "920282966",
"telephone_number": "760-728-1607",
"fax_number": "760-728-2398"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PACIFIC PHARMACY GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-08",
"last_updated": "2014-02-05",
"status": "A",
"authorized_official_last_name": "BALTHASAR",
"authorized_official_first_name": "JAN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "949-215-5522"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY49043",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "1992005",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1235208570",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FALLBROOK PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fallbrook, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.