Jafa Pharmaceuticals, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY55615 Issued in CA

Legal business name

JAFA PHARMACEUTICALS, INC.

Doing business as

Creekside Pharmacy

Practice address

95 Montgomery Dr
Santa Rosa, CA 95404

Phone

(707) 525-1130

Fax

(707) 525-8099

NPI assigned

Dec 6, 2006

Organization subpart

No

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

Authorized official

Name

Tony Ibrahim

Title

Ceo

Phone

(760) 987-6796

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Creekside Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Creekside Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jafa Pharmaceuticals, Inc.

  • Long Term Care Pharmacy
  • Santa Rosa, CA
  • NPI 1629604368
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anyamanee Malakham, RPH

  • Pharmacist
  • Santa Rosa, CA
  • NPI 1376209619
  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1497814594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 MONTGOMERY DR",
            "address_2": "SUITE 108",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954046630",
            "telephone_number": "707-525-1130",
            "fax_number": "707-525-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95404",
            "telephone_number": "707-525-1130",
            "fax_number": "707-525-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAFA PHARMACEUTICALS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-987-6796"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY55615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2126477",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creekside Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle Lorraine Jackson, ASW
• Joshua Jacober, MD
• Gerald D. Jacobs
• Robert Louis Jacobs
• Mark Edwin Jacobson, MD
• Jafa Pharmaceuticals, Inc.
• Mahsa Sadat Jafari
• Robert Torin Jaffe, M.D.
• Ida Jahed, MD
• Lucelene Jaimes Perez

• Community/Retail Pharmacy in Santa Rosa, CA
• Providers in Santa Rosa, 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 Nov 8, 2024; 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.

Verify at the official NPI Registry.