Organization · Type 2 NPI

Coram Alternate Site Services Inc

Home Infusion Therapy Pharmacy · San Diego, CA

NPI number 1790734036 Active

Practice location

12310 World Trade Dr, Suite 100
San Diego, CA 92128-3793

Call (858) 576-6969 Map

Fax (858) 974-6606

Mailing address

PO Box 646674
Cincinnati, OH 45264-6674

Specialties and licenses

Taxonomy	Code	License
Home Health Agency	251E00000X	0800429 (CA)
Home Infusion Agency	251F00000X	0800429 (CA)
Infusion Therapy Clinic/Center	261QI0500X	None listed
Durable Medical Equipment & Medical Supplies	332B00000X	PHY50273 (CA)
Parenteral & Enteral Nutrition Supplies (DME)	332BP3500X	PHY50273 (CA)
Pharmacy	333600000X	PHY50273 (CA)
Community/Retail Pharmacy	3336C0003X	PHY50273 (CA)
Compounding Pharmacy	3336C0004X	PHY50273 (CA)
Home Infusion Therapy Pharmacy Primary	3336H0001X	PHY50273 (CA)
Mail Order Pharmacy	3336M0002X	PHY50273 (CA)
Specialty Pharmacy	3336S0011X	PHY50273 (CA)

Home Infusion Therapy Pharmacy: Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusio…

Another provider at this address

Kyung Mo Koo, PharmDPharmacist San Diego, CA NPI 1144856014

Other home infusion therapy pharmacy providers in San Diego

See all in San Diego →

NPI record

NPI: 1790734036
Entity type: Organization (Type 2)
Issued: May 5, 2006
Last updated: Sep 3, 2026
Status: Active
Subpart: Yes of Coram Alternate Site Services Inc

Other names

<unavail>
Coram Cvs/specialty Infusion Services · doing business as
Coram Cvs/specialty Infusion Services · doing business as

Authorized official

Ashley Czonstkowsky
President
(401) 765-1500

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1790734036

Coram Alternate Site Services Inc's National Provider Identifier is 1790734036, issued on May 5, 2006. The primary taxonomy on file is Home Infusion Therapy Pharmacy (3336H0001X), and the practice location is in San Diego, CA. The record was last updated on Sep 3, 2026.