Healthcare Provider Details

I. General information

NPI: 1710059597
Provider Name (Legal Business Name): THE CAMARILLO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date: 04/30/2008
Reactivation Date: 05/30/2008

III. Provider practice location address

2173 PICKWICK DR
CAMARILLO CA
93010-6426
US

IV. Provider business mailing address

2173 PICKWICK DR
CAMARILLO CA
93010-6426
US

V. Phone/Fax

Practice location:
  • Phone: 805-389-5311
  • Fax: 805-389-5309
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENA FERMAN
Title or Position: THIRD PARTY PLAN COORDINATOR
Credential:
Phone: 314-993-6000