Provider Demographics
NPI:1679646202
Name:FARMACIA REMEDIOS INC
Entity type:Organization
Organization Name:FARMACIA REMEDIOS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-377-5525
Mailing Address - Street 1:201 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3352
Mailing Address - Country:US
Mailing Address - Phone:408-920-0781
Mailing Address - Fax:408-920-0782
Practice Address - Street 1:201 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-3352
Practice Address - Country:US
Practice Address - Phone:408-920-0781
Practice Address - Fax:408-920-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY482883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5624526OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA487270Medicaid