=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912343344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALIFORNIA ASSISTED PHARMACY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2013
-----------------------------------------------------
Last Update Date | 08/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 646 E 28TH ST STE #1
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-631-1000
-----------------------------------------------------
Fax | 877-866-2770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8631 CLIFTON WAY
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-631-1000
-----------------------------------------------------
Fax | 877-866-2770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | DR. JACOB HANAIE
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 818-631-1000
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | PHY50641
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------