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Organization

PSR WELLNESS LLC

Active
Other names
SILVERADO PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
PRATAP K ANNE (PHARMACY DIRECTOR)
(209) 298-1715
Entity
Organization

Contact information

Practice address
1473 - D LINCOLN AVENUE, CALISTOGA, CA 94515-1479
(707) 942-5115
(707) 942-2175
Mailing address
1473 - D LINCOLN AVENUE, CALISTOGA, CA 94515-1479
(209) 298-1715
(559) 369-2408

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
PHY47475
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1700946936
CA
01
2033136
PK
Enumeration date
12/11/2006
Last updated
03/20/2025
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