MEDICARE: ASBAC PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY48237	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1998060	OTHER		PK

General Provider Information

NPI Number	:	1205925989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASBAC PHARMACY INC

Provider Business Mailing Address
First Line	:	161 THUNDER DR
Second Line	:	SUITE 100
City	:	VISTA
State	:	CA
Zip	:	92083-6016
Country	:	US
Telephone Number	:	760-758-7650
Fax Number	:	760-758-8228

Provider Business Practice Location Address
First Line	:	161 THUNDER DR
Second Line	:	SUITE 100
City	:	VISTA
State	:	CA
Zip	:	92083-6016
Country	:	US
Telephone Number	:	760-758-7650
Fax Number	:	760-758-8228

Authorized Official
Title or Position	:	PRES
Name	:	JOSEPH DEVINS
Credential	:	RPH
Telephone Number	:	760-758-7650

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	11/14/2016

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Directions to “ASBAC PHARMACY INC ” Practice Location

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