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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