Organization
MARIPOSA DRUG CO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK RADANOVICH (PHARMACIST IN CHARGE)
(209) 966-3315
Entity
Organization
Contact information
Practice address
5034 HWY 140 6TH & CHARLES ST, MARIPOSA, CA 95338
(209) 966-3315
(209) 966-6131
Mailing address
PO BOX 67, MARIPOSA, CA 95338-0067
(209) 966-3315
(209) 966-6131
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY10528
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0537576
NABP
CA
05
—
PHA105280
—
CA
Enumeration date
02/09/2007
Last updated
08/22/2020
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