Organization
JAFA PHARMACEUTICALS, INC.
Active
Other names
Creekside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TONY IBRAHIM (CEO)
(760) 987-6796
Entity
Organization
Contact information
Practice address
95 MONTGOMERY DR, SANTA ROSA, CA 95404
(707) 525-1130
(707) 525-8099
Mailing address
95 MONTGOMERY DR, SUITE 108, SANTA ROSA, CA 95404-6630
(707) 525-1130
(707) 525-8099
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY55615
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126477
PK
—
Enumeration date
12/06/2006
Last updated
11/08/2024
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