1972518629 NPI number — CALMONT PHARMACY INC

Table of content: (NPI 1972518629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972518629 NPI number — CALMONT PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALMONT PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALMONT PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972518629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 N CALIFORNIA ST
Provider Second Line Business Mailing Address:
STE 9
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-943-7676
Provider Business Mailing Address Fax Number:
209-943-7680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 N CALIFORNIA ST
Provider Second Line Business Practice Location Address:
STE 9
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-943-7676
Provider Business Practice Location Address Fax Number:
209-943-7680
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
VIJAY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT PHARMACIST
Authorized Official Telephone Number:
209-943-7676

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHY46669 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1972518629 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0500163 . This is a "NCPDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHA466690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".