1598857831 NPI number — DOS CAMINOS PHARMACY INC

Table of content: (NPI 1598857831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598857831 NPI number — DOS CAMINOS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOS CAMINOS PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598857831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2412 PONDEROSA DR NORTH
Provider Second Line Business Mailing Address:
SUITE B106
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010-4724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-484-1059
Provider Business Mailing Address Fax Number:
805-484-1050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2412 PONDEROSA DR NORTH
Provider Second Line Business Practice Location Address:
SUITE B106
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-484-1059
Provider Business Practice Location Address Fax Number:
805-484-1050
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TARANTINO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER PHARMACIST IN CHARGE
Authorized Official Telephone Number:
805-484-1059

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY21839 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA218390 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0573940 . This is a "NABP #" identifier . This identifiers is of the category "OTHER".




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