Provider Demographics
NPI:1245246032
Name:EITOKU COMPANY INC
Entity Type:Organization
Organization Name:EITOKU COMPANY INC
Other - Org Name:GONZALES RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:KEN
Authorized Official - Last Name:EITOKU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:831-675-3643
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:CA
Mailing Address - Zip Code:93926-0808
Mailing Address - Country:US
Mailing Address - Phone:831-675-3643
Mailing Address - Fax:831-675-3086
Practice Address - Street 1:18 4TH STREET
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:CA
Practice Address - Zip Code:93926-0808
Practice Address - Country:US
Practice Address - Phone:831-675-3643
Practice Address - Fax:831-675-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY438083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA438080Medicaid
CAPHA438080Medicaid