Provider Demographics
NPI:1134294713
Name:PRICE LESS PHARMACY
Entity Type:Organization
Organization Name:PRICE LESS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PHCY SVCS
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:916-638-0214
Mailing Address - Street 1:2210 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2210 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4377
Practice Address - Country:US
Practice Address - Phone:916-638-0214
Practice Address - Fax:916-638-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY30552333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0580680OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA305520Medicaid
CAPHA305520Medicaid