NPIMap

Organization Active NPI

San Diego Compounding Pharmacy

  • Community/Retail Pharmacy
  • San Diego, CA
National Provider Identifier
1730257593
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY99276 Issued in CA
Legal business name
SAN DIEGO COMPOUNDING PHARMACY
Practice address
5395 Ruffin Road
#104
San Diego, CA 92123
Phone
(858) 277-8884
Fax
(858) 277-8889
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jerome Alan Greene, RPH FACA
Title
Pharmacist Owner
Phone
(858) 277-8884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHY99276 CA Primary

Addresses

Primary practice location

5395 Ruffin Road
#104
San Diego, CA 92123

Mailing address

5395 Ruffin Road
#104
San Diego, CA 92123
Phone (858) 277-8884

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730257593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5395 RUFFIN ROAD",
            "address_2": "#104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92123",
            "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 ROAD",
            "address_2": "#104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92123",
            "telephone_number": "858-277-8884",
            "fax_number": "858-277-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PHARMACIST OWNER",
        "authorized_official_telephone_number": "858-277-8884",
        "authorized_official_credential": "RPH FACA"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY99276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.