Organization
ALCOSTA PHARMACY ASSOCIATES INC
Active
Other names
Custom Care Compounding
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KAY CLAUSER (TREASUER)
(925) 830-0581
Entity
Organization
Contact information
Practice address
124 MARKET PL, SAN RAMON, CA 94583-4740
(925) 830-4631
(925) 830-0125
Mailing address
124 MARKET PL, SAN RAMON, CA 94583-4740
(925) 830-4631
(925) 830-0125
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY41451
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2036044
PK
—
05
—
PHA414510
—
CA
Enumeration date
08/10/2006
Last updated
07/19/2018
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