=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821324229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRONIC CARE MEDICINALS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2009
-----------------------------------------------------
Last Update Date | 10/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3463 STATE ST # 175
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93105-2662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-232-6866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3463 STATE ST # 175
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93105-2662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-232-6866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ORGANIZER
-----------------------------------------------------
Name | MS. DELIA L. WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-232-6866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------