Active NPI
South Gate Rose Phcy Inc
- Long Term Care Pharmacy
- Buena Park, CA
National Provider Identifier
1396756805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- SOUTH GATE ROSE PHCY INC
- Doing business as
- BLUE ROSE PHARMACY
- Practice address
- 8615 Knott Ave
Ste 7
Buena Park, CA 90620-3841 - Phone
- (714) 952-4978
- Fax
- (714) 953-6868
- NPI assigned
- Aug 10, 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
- Javier Zamora
- Title
- Cfo
- Phone
- (714) 350-3009
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHY47605 | CA | |
| Long Term Care Pharmacy | 3336L0003X | Primary |
Addresses
Primary practice location
8615 Knott Ave
Ste 7
Buena Park, CA 90620-3841
Mailing address
8615 Knott Ave
Ste 7
Buena Park, CA 90620-3841
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5622990 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- BLUE ROSE PHARMACY
National Provider Directory
National Provider Directory- Tax ID family
- Blue Rose Pharmacy
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ambulatory Family Planning Facility
- Santa Ana, CA
- NPI 1932283140
-
- Ambulatory Family Planning Facility
- Buena Park, CA
- NPI 1528144664
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1396756805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8615 KNOTT AVE",
"address_2": "STE 7",
"city": "BUENA PARK",
"state": "CA",
"postal_code": "906203841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8615 KNOTT AVE",
"address_2": "STE 7",
"city": "BUENA PARK",
"state": "CA",
"postal_code": "906203841",
"telephone_number": "714-952-4978",
"fax_number": "714-953-6868"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTH GATE ROSE PHCY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-10",
"last_updated": "2025-09-11",
"status": "A",
"authorized_official_last_name": "ZAMORA",
"authorized_official_first_name": "JAVIER",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "714-350-3009"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY47605",
"primary": false
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "5622990",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "BLUE ROSE PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Buena Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.