Provider Demographics
NPI:1073514303
Name:PILLCO PHARMACY
Entity Type:Organization
Organization Name:PILLCO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARCIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MASCARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:619-470-4550
Mailing Address - Street 1:2939 ALTA VIEW DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3394
Mailing Address - Country:US
Mailing Address - Phone:619-470-4550
Mailing Address - Fax:619-470-6709
Practice Address - Street 1:2939 ALTA VIEW DR
Practice Address - Street 2:SUITE L
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3394
Practice Address - Country:US
Practice Address - Phone:619-470-4550
Practice Address - Fax:619-470-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA357590Medicaid