Nipomo Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY50681 Issued in CA

Legal business name

NIPOMO PHARMACY INC

Practice address

695 W Tefft St Ste a
Nipomo, CA 93444-9395

Phone

(805) 929-1929

Fax

(888) 590-0871

NPI assigned

Jul 26, 2011

Organization subpart

No

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

Authorized official

Name

Gholam RouzitalabNPI 1306359534

Title

Vice President

Phone

(805) 929-1929

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• nipomo rexall drugs Doing business as

Locations

Practitioners 2

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

• Gholam H Rouzitalab, RPH

  • Pharmacist
  • Lake Elsinore, CA
  • NPI 1306359534
  NPD Authorized official
• Jessica Mashayekhan, PHARMD

  • Pharmacist
  • La Jolla, CA
  • NPI 1104661099
  NPD

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1619255544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 W TEFFT ST STE A",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934449395",
            "telephone_number": "805-929-1929",
            "fax_number": "888-590-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 W TEFFT ST STE A",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934449395",
            "telephone_number": "805-929-1929",
            "fax_number": "888-590-0871"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 W Tefft St",
            "address_purpose": "LOCATION",
            "city": "Nipomo",
            "state": "CA",
            "postal_code": "934448876",
            "country_code": "US",
            "telephone_number": "805-929-1929",
            "fax_number": "805-929-2041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NIPOMO PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-26",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "ROUZITALAB",
        "authorized_official_first_name": "GHOLAM",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "805-929-1929"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY50681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5641546",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2131346",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "nipomo rexall drugs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "nipomo rexall drugs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Belinda Leah Morabito
• Chin Chon NG Chan
• NG Dental Corp
• Nipomo Dental Group of Andrew Young DDS Inc
• Nipomo Optometry Inc
• Shannon R Olson, DDS
• Romeo S Ortiz, MD
• Ostatnigrosh Williams Chiropractic Professional Corporation
• Pacific Central Coast Health Centers
• Pacific Central Coast Health Centers

• Community/Retail Pharmacy in Nipomo, CA
• Providers in Nipomo, 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 Mar 22, 2022; 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.