# EUREKA PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CLONEYS LONG TERM CARE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164713517
- **Authorized official:** MR. PRATAP KRISHNA ANNE (MANAGING MEMBER)
- **Authorized official phone:** (209) 298-1715

## Contact information

- **Practice address:** 525 5TH ST STE B, EUREKA, CA 95501-1032
- **Practice address phone:** (707) 443-8452
- **Practice address fax:** (707) 443-2443
- **Mailing address:** 525 5TH ST, EUREKA, CA 95501-1032
- **Mailing address phone:** (707) 443-8452
- **Mailing address fax:** (707) 443-3059

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 04/20/2011
- **Last updated:** 08/10/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1164713517 | — | CA |
| 01 | — | 2129858 | PK | — |