Southern California Compounding Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PHY49147 Issued in CA

Legal business name

SOUTHERN CALIFORNIA COMPOUNDING PHARMACY

Practice address

11125 Flintkote Ave Ste F
San Diego, CA 92121-1213

Phone

(858) 622-1278

Fax

(858) 622-1283

NPI assigned

Dec 3, 2008

Organization subpart

No

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

Authorized official

Name

Ollen Williams

Title

Technician

Phone

(858) 622-1278

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Southern California Compounding Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445558400000",
    "number": "1669617734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11125 FLINTKOTE AVE STE F",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211213",
            "telephone_number": "858-622-1278",
            "fax_number": "858-622-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11125 FLINTKOTE AVE STE F",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211213",
            "telephone_number": "858-622-1278",
            "fax_number": "858-622-1283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-03",
        "last_updated": "2015-10-23",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "OLLEN",
        "authorized_official_title_or_position": "TECHNICIAN",
        "authorized_official_telephone_number": "858-622-1278"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CA",
            "license": "PHY49147",
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117954",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern California Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Compounding Pharmacy in San Diego, CA
• Providers in San Diego, CA by specialty
• Compounding Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.