Organization
SHASTA LAKE DRUG STORE INC
Active
Other names
Shasta Lake Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
JODI WALSH (OFFICER/SECRETARY)
(530) 339-1445
Entity
Organization
Contact information
Practice address
4222 SHASTA DAM BLVD, SHASTA LAKE, CA 96019-9422
(530) 275-2700
(530) 275-2800
Mailing address
PO BOX 991179, REDDING, CA 96099-1179
(530) 275-2700
(530) 275-2800
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
51277
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138099
PK
—
05
—
PHA512770
—
CA
Enumeration date
07/10/2013
Last updated
08/01/2013
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