Healthcare Provider Details

I. General information

NPI: 1700883964
Provider Name (Legal Business Name): CALIFORNIA PACIFIC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 9TH ST
LOS ANGELES CA
90015-1377
US

IV. Provider business mailing address

1000 W 9TH ST
LOS ANGELES CA
90015-1377
US

V. Phone/Fax

Practice location:
  • Phone: 213-489-1282
  • Fax: 213-239-5039
Mailing address:
  • Phone: 213-489-1282
  • Fax: 213-239-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY30386
License Number StateCA

VIII. Authorized Official

Name: MARTIN LINSK
Title or Position: PRESIDENT
Credential:
Phone: 213-489-2672