Provider Demographics
NPI:1063540821
Name:EL CAMINO PHARMACY
Entity type:Organization
Organization Name:EL CAMINO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FURUKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-729-2405
Mailing Address - Street 1:1005 CARLSBAD VILLAGE DR STE D2
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1883
Mailing Address - Country:US
Mailing Address - Phone:760-729-2405
Mailing Address - Fax:
Practice Address - Street 1:1005 CARLSBAD VILLAGE DR STE D2
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1883
Practice Address - Country:US
Practice Address - Phone:760-729-2405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA182903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy