Organization
PATRICK K CROSBY
Active
Organization
PATRICK K CROSBY
Active
Other names
GROVELAND PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK CROSBY BS (OWNER)
(209) 962-5211
Entity
Organization
Contact information
Practice address
18638 MAIN ST, GROVELAND, CA 95321-9458
(209) 962-5211
(209) 962-0963
Mailing address
PO BOX 809, GROVELAND, CA 95321-0809
(209) 962-5211
(209) 962-0963
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
4743490001
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY39864
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0586416
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
GM613A
PTAN FOR MASS IMMUNIZATION ROSTER BILLER
CA
Enumeration date
09/22/2005
Last updated
04/16/2014
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