Provider Demographics
NPI:1053625749
Name:CLINICARE PHARMACY INC
Entity type:Organization
Organization Name:CLINICARE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AROUCHANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, APH
Authorized Official - Phone:818-727-7234
Mailing Address - Street 1:9245 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3137
Mailing Address - Country:US
Mailing Address - Phone:818-727-7234
Mailing Address - Fax:
Practice Address - Street 1:9245 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3137
Practice Address - Country:US
Practice Address - Phone:818-727-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
CA542743336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130612OtherPK
CAPHA473870Medicaid
5604450001Medicare NSC
CAPHY47387OtherBOARD OF PHARMACY PERMIT