Healthcare Provider Details

I. General information

NPI: 1962517995
Provider Name (Legal Business Name): NORTH COAST MEDICAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL STE B101
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

PO BOX 230968
ENCINITAS CA
92023-0968
US

V. Phone/Fax

Practice location:
  • Phone: 760-943-1191
  • Fax: 760-943-8328
Mailing address:
  • Phone: 760-943-1191
  • Fax: 760-943-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48341
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HAMIDREZA SABOURI
Title or Position: CFO
Credential:
Phone: 760-943-1191