=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679101703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZANE PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2020
-----------------------------------------------------
Last Update Date | 11/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23653 EL TORO RD STE A
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-8614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-888-9697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23653 EL TORO RD STE A
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-8614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-586-7780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/OWNER
-----------------------------------------------------
Name | AMR Y ELSAYED
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 949-586-7780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------