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General NPI Number Information
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NPI Number | 1235208570
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Entity Type | Organization
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Legal Business Name | PACIFIC PHARMACY GROUP
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 343 E ALVARADO ST
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City | FALLBROOK
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State | CA
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Zip | 92028-2966
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Country | US
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Telephone | 760-728-1607
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Fax | 760-728-2398
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Provider Business Mailing Address
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Address Line | 1010 W LA VETA AVE SUITE 130
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City | ORANGE
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State | CA
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Zip | 92868-4300
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Country | US
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Telephone | 949-215-5522
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Fax | 949-215-8988
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Authorized Official
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Title or Position | CEO
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Name | JAN BALTHASAR
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Credential |
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Telephone | 949-215-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY49043
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License Number State | CA
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