Healthcare Provider Details

I. General information

NPI: 1396900353
Provider Name (Legal Business Name): OC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31654 RANCHO VIEJO RD STE N
SAN JUAN CAPISTRANO CA
92675-2773
US

IV. Provider business mailing address

31654 RANCHO VIEJO RD STE N
SAN JUAN CAPISTRANO CA
92675-2773
US

V. Phone/Fax

Practice location:
  • Phone: 949-429-5326
  • Fax: 949-429-5328
Mailing address:
  • Phone: 800-429-5102
  • Fax: 949-429-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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 Number49085
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: OMEED ASKARI
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 949-429-5326