Provider Demographics
NPI:1689401630
Name:CENTRAL COAST RX INC
Entity type:Organization
Organization Name:CENTRAL COAST RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-460-9600
Mailing Address - Street 1:5735 EL CAMINO REAL STE H
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3350
Mailing Address - Country:US
Mailing Address - Phone:805-460-9600
Mailing Address - Fax:805-460-9699
Practice Address - Street 1:5735 EL CAMINO REAL STE H
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3350
Practice Address - Country:US
Practice Address - Phone:805-460-9600
Practice Address - Fax:805-460-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy