Organization
SANTA CLARA DRUG
Active
Other names
SANTA CLARA DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
LOUISE GIBINO (PRESIDENT)
(408) 296-5015
Entity
Organization
Contact information
Practice address
2453 FOREST AVE, SAN JOSE, CA 95128-1505
(408) 296-5015
(408) 248-2790
Mailing address
2453 FOREST AVE, SAN JOSE, CA 95128-1505
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY39079
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0548531
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA390790
—
CA
Enumeration date
08/10/2006
Last updated
05/28/2009
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