Poway Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

55623 Issued in CA

Legal business name

POWAY PHARMACY LLC

Doing business as

Poway Pharmacy

Practice address

14837 Pomerado Rd
Poway, CA 92064-2803

Phone

(858) 842-4206

Fax

(951) 674-9773

NPI assigned

Aug 1, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Gholam Rouzitalab, PHARM.D.

Title

Pharmacist in Charge

Phone

(858) 842-4206

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Poway Pharmacy Doing business as

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520899200000",
    "number": "1831613793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14837 POMERADO RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642803",
            "telephone_number": "858-842-4206",
            "fax_number": "858-842-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14837 POMERADO RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642803",
            "telephone_number": "858-842-4206",
            "fax_number": "951-674-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWAY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-01",
        "last_updated": "2018-03-13",
        "status": "A",
        "authorized_official_last_name": "ROUZITALAB",
        "authorized_official_first_name": "GHOLAM",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "858-842-4206",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM.D."
    },
    "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": "55623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2170472",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poway Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Poway Emergency Physicians, Inc
• Poway Gardens Memory Care LLC
• Poway Hospitalist Medical Group, Inc
• Poway Intensivist Medical Group, Inc
• Poway Medical Clinic, Incorporated
• Poway Surgery Center
• Heather Preber, D.M.D.
• Precision Orthopedics and Sports Medicine
• Larry Alan Presant, MD
• Erica Price

• Community/Retail Pharmacy in Poway, CA
• Providers in Poway, 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 13, 2018; 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.