Healthcare Provider Details

I. General information

NPI: 1295210722
Provider Name (Legal Business Name): SOCAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 GARDEN GROVE BLVD STE 102
GARDEN GROVE CA
92843-1903
US

IV. Provider business mailing address

12555 GARDEN GROVE BLVD STE 102
GARDEN GROVE CA
92843-1903
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-0593
  • Fax: 714-636-7708
Mailing address:
  • Phone: 714-636-0593
  • Fax: 714-636-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUDY COLEMAN
Title or Position: BILLING MANAGER
Credential: MRS
Phone: 714-636-0593