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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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