Provider Demographics
NPI:1730385949
Name:PACIFIC PHARMACY SERVICE INC
Entity type:Organization
Organization Name:PACIFIC PHARMACY SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-327-4881
Mailing Address - Street 1:174 S SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6737
Mailing Address - Country:US
Mailing Address - Phone:760-327-4881
Mailing Address - Fax:760-322-1807
Practice Address - Street 1:174 S SUNRISE WAY
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6737
Practice Address - Country:US
Practice Address - Phone:760-327-4881
Practice Address - Fax:760-322-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA487190Medicaid
CA5627382OtherNCPDP
CA5627382OtherNCPDP
CA6038470001Medicare NSC