Healthcare Provider Details

I. General information

NPI: 1730526781
Provider Name (Legal Business Name): PACIFIC PHARMACY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 E ALVARADO ST SUITE C
FALLBROOK CA
92028-2966
US

IV. Provider business mailing address

343 E ALVARADO ST SUITE C
FALLBROOK CA
92028-2966
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-6142
  • Fax: 760-728-6382
Mailing address:
  • Phone: 760-728-6142
  • Fax: 760-728-6382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number51247
License Number StateCA

VIII. Authorized Official

Name: JAN BALTHASAR
Title or Position: CEO
Credential:
Phone: 949-215-5522