Provider Demographics
NPI:1235148412
Name:MCCORMACK DRUGS INC
Entity Type:Organization
Organization Name:MCCORMACK DRUGS INC
Other - Org Name:TENTH STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:408-294-9131
Mailing Address - Street 1:448 E SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-1913
Mailing Address - Country:US
Mailing Address - Phone:408-294-9131
Mailing Address - Fax:408-294-5957
Practice Address - Street 1:448 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1913
Practice Address - Country:US
Practice Address - Phone:408-294-9131
Practice Address - Fax:408-294-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY122583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY122580Medicaid
0546234OtherNCPDP
0923940001Medicare ID - Type Unspecified