Provider Demographics
NPI:1154617215
Name:SENIOR CARE PHARMACY SERVICES FAIRFIELD INC
Entity type:Organization
Organization Name:SENIOR CARE PHARMACY SERVICES FAIRFIELD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-891-1800
Mailing Address - Street 1:PO BOX 27458
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0115
Mailing Address - Country:US
Mailing Address - Phone:714-891-1800
Mailing Address - Fax:714-891-1102
Practice Address - Street 1:4950 FULTON DR
Practice Address - Street 2:SUITE A AND B
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1615
Practice Address - Country:US
Practice Address - Phone:707-673-9800
Practice Address - Fax:707-673-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336I0012X
CAPHY506193336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5641332OtherNCPDP PROVIDER IDENTIFICATION NUMBER