Organization
MOTHER LODE PHARMACIES, INC.
Active
Other names
KELLY'S DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND L GUIDI RPH (PRESIDENT)
(209) 754-3595
Entity
Organization
Contact information
Practice address
64 E. SAINT CHARLES ST, SAN ANDREAS, CA 95249-0009
(209) 754-3595
(209) 754-5387
Mailing address
PO BOX 606, SAN ANDREAS, CA 95249-0606
(209) 754-3595
(209) 754-5387
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
417030
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA417030
—
CA
Enumeration date
10/17/2006
Last updated
08/22/2020
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