Organization
PACIFIC PHARMACY GROUP
Active
Other names
FALLBROOK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAN BALTHASAR (CEO)
(949) 215-5522
Entity
Organization
Contact information
Practice address
343 E ALVARADO ST, FALLBROOK, CA 92028-2966
(760) 728-1607
(760) 728-2398
Mailing address
1010 W LA VETA AVE, SUITE 130, ORANGE, CA 92868-4300
(949) 215-5522
(949) 215-8988
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY49043
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235208570
—
CA
01
—
1992005
PK
—
Enumeration date
11/08/2006
Last updated
02/05/2014
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