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Organization
SOUTHERN CALIFORNIA COMPOUNDING PHARMACY
Active
Organization
SOUTHERN CALIFORNIA COMPOUNDING PHARMACY
Active
Other names
Southern California Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
OLLEN WILLIAMS (TECHNICIAN)
(858) 622-1278
Entity
Organization
Contact information
Practice address
11125 FLINTKOTE AVE STE F, SAN DIEGO, CA 92121-1213
(858) 622-1278
(858) 622-1283
Mailing address
11125 FLINTKOTE AVE STE F, SAN DIEGO, CA 92121-1213
(858) 622-1278
(858) 622-1283
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY49147
CA
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2117954
PK
—
Enumeration date
12/03/2008
Last updated
10/23/2015
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