Organization
MAGIC POTION INC
Active
Other names
THE MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
GENNADY SOSKIN PHARM.D. (OWNER/PHARMACIST)
(949) 830-8500
Entity
Organization
Contact information
Practice address
24602 RAYMOND WAY, SUITE B, LAKE FOREST, CA 92630-4461
(949) 830-8500
(949) 830-9884
Mailing address
24602 RAYMOND WAY, SUITE B, LAKE FOREST, CA 92630-4461
(949) 830-8500
(949) 830-9884
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY47205
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0528034
NABP
CA
05
—
PHA472050
—
CA
Enumeration date
12/26/2006
Last updated
03/07/2023
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