=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407657869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CC CARE RX INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2025
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23928 LYONS AVE STE 110
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-753-3290
-----------------------------------------------------
Fax | 661-753-3291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23928 LYONS AVE STE 110
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-753-3290
-----------------------------------------------------
Fax | 661-753-3291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY/DIRECTOR/PIC
-----------------------------------------------------
Name | ELHAM FALAHATI
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 661-753-3290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------