San Diego Compounding Pharmacy a Prof Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY47015 Issued in CA

Legal business name

SAN DIEGO COMPOUNDING PHARMACY A PROF CORP

Practice address

5395 Ruffin Rd Ste 104
San Diego, CA 92123-1338

Phone

(858) 277-8884

Fax

(858) 277-8889

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Jerome Greene

Title

Owner

Phone

(858) 277-8884

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• SAN DIEGO COMPOUNDING PHARMACY Doing business as

Tax ID family

San Diego Compounding 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.

• San Diego Compounding Pharmacy

  • Community/Retail Pharmacy
  • San Diego, CA
  • NPI 1730257593
  NPD tax ID

Locations

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471824000000",
    "number": "1508877002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5395 RUFFIN RD STE 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231338",
            "telephone_number": "858-277-8884",
            "fax_number": "858-277-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5395 RUFFIN RD STE 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231338",
            "telephone_number": "858-277-8884",
            "fax_number": "858-277-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO COMPOUNDING PHARMACY A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2016-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "858-277-8884"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY47015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2113433",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN DIEGO COMPOUNDING PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• San Diego City of Refuge
• San Diego Co. Superintendent of Schools
• San Diego Coastal Caregivers,LLC
• San Diego Community Pharmacy
• San Diego Compounding Pharmacy
• San Diego Comprehensive Pain Management Center, Inc
• San Diego Comprehensive Pain Management Inc
• San Diego Comprehensive Pain Management Inc
• San Diego County
• San Diego County Case Management

• 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 Aug 22, 2016; 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.