Healthcare Provider Details

I. General information

NPI: 1447508890
Provider Name (Legal Business Name): PAS SPECIALTY PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 RANCHO RD STE 7
THOUSAND OAKS CA
91362-6000
US

IV. Provider business mailing address

60 RANCHO RD STE 7
THOUSAND OAKS CA
91362-6000
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-9200
  • Fax: 805-379-3900
Mailing address:
  • Phone: 805-379-9200
  • Fax: 805-379-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHY50915
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN NAGENGAST
Title or Position: CEO
Credential:
Phone: 805-556-5137