Organization
SHASTA LAKE DRUG STORE INC
Active
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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