Organization
MEDICAL TREE PHARMACY INC
Active
Other names
MEDICAL CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TOM DEMBASKI (OWNER)
(408) 426-0200
Entity
Organization
Contact information
Practice address
2025 SOQUEL AVE, SANTA CRUZ, CA 95062-1323
(831) 426-0200
(831) 426-0507
Mailing address
2025 SOQUEL AVE, SANTA CRUZ, CA 95062-1323
(831) 426-0200
(831) 426-0507
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY21201
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115560
PK
—
05
—
PHA212010
—
CA
Enumeration date
08/10/2006
Last updated
06/17/2016
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