MEDICARE: CALIFORNIA PACIFIC 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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY30386	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2002311	OTHER		PK

General Provider Information

NPI Number	:	1700883964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA PACIFIC PHARMACY INC

Provider Business Mailing Address
First Line	:	1000 W 9TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-1377
Country	:	US
Telephone Number	:	213-489-1282
Fax Number	:	213-239-5039

Provider Business Practice Location Address
First Line	:	1000 W 9TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-1377
Country	:	US
Telephone Number	:	213-489-1282
Fax Number	:	213-239-5039

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARTIN LINSK
Credential	:
Telephone Number	:	213-489-2672

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	12/26/2014

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