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General NPI Number Information
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NPI Number | 1821242421
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Entity Type | Organization
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Legal Business Name | ASSURED PHARMACY
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 2040 PACIFIC COAST HWY STE R
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City | LOMITA
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State | CA
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Zip | 90717-2660
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Country | US
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Telephone | 949-222-9971
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Fax | 949-271-5580
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Provider Business Mailing Address
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Address Line | 17935 SKY PARK CIR STE F
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City | IRVINE
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State | CA
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Zip | 92614-6321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CONTRACTING ADMINISTRATOR
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Name | TYLER ROBLES
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Credential |
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Telephone | 949-222-9971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY 48925
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License Number State | CA
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