Organization
MOUNT SHASTA PHARMACY, INC.
Active
Other names
Mount Shasta Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TONY IBRAHIM (CEO)
(760) 987-6796
Entity
Organization
Contact information
Practice address
148 MORGAN WAY, MOUNT SHASTA, CA 96067
(530) 568-0270
(530) 568-0271
Mailing address
148 MORGAN WAY, MOUNT SHASTA, CA 96067
(530) 568-0270
(530) 568-0271
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
10/06/2023
Last updated
10/06/2023
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