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General NPI Number Information
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NPI Number | 1720313257
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Entity Type | Organization
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Legal Business Name | C&A MEDICAL 1
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 22642 LAMBERT ST STE 404
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City | LAKE FOREST
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State | CA
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Zip | 92630-1645
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Country | US
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Telephone | 949-347-8881
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Fax | 949-347-8886
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Provider Business Mailing Address
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Address Line | 22642 LAMBERT ST SUITE 404
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City | LAKE FOREST
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State | CA
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Zip | 92630-1610
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Country | US
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Telephone | 949-347-8881
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Fax | 949-347-8886
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARYAM SHARAFSALEH
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Credential |
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Telephone | 760-212-2761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 49911
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License Number State | CA
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