Healthcare Provider Details

I. General information

NPI: 1942220439
Provider Name (Legal Business Name): PAIN MANAGEMENT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 S MILLER ST
SANTA MARIA CA
93454-7849
US

IV. Provider business mailing address

2003 S MILLER ST
SANTA MARIA CA
93454-7849
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-4700
  • Fax: 805-928-4710
Mailing address:
  • Phone: 805-928-4700
  • Fax: 805-928-4710

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 NumberPHY46656
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KENNETH GUESS
Title or Position: CEO VP
Credential: PHARMD
Phone: 805-928-4700