Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 333600000X | Pharmacy | | PHY21926 | CALIFORNIA | No |
| 2 | 183500000X | Pharmacist | | RPH 33277 | CALIFORNIA | No |
| 3 | 332B00000X | Durable Medical Equipment & Medical Supplies | | PHY21926 | CALIFORNIA | No |
| 4 | 3336C0003X | Pharmacy | Community/Retail Pharmacy | PHY 21926 | CALIFORNIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | PHA 219260 | MEDICAID | CALIFORNIA | |
| 2 | AR 1471933 | OTHER | | D E A LICENCE |
| 3 | RPH 33277 | OTHER | CALIFORNIA | STATE PHARMACIST LICENCE |
| 4 | PHY 21926 | OTHER | CALIFORNIA | STATE PHARMACY LICENCE |
| 5 | 1396754891 | OTHER | | NPI |
| 6 | 5671030001 | MEDICARE ID-TYPE UNSPECIFIED | | MEDICARE PROVIDER NUMBER |
