Provider Demographics
NPI:1275794307
Name:TRI-CITY PHARMACY
Entity Type:Organization
Organization Name:TRI-CITY PHARMACY
Other - Org Name:TRI-CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASRAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:510-366-9218
Mailing Address - Street 1:1132 CADILLAC CT
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3058
Mailing Address - Country:US
Mailing Address - Phone:408-935-9120
Mailing Address - Fax:408-935-9121
Practice Address - Street 1:1132 CADILLAC CT
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-3058
Practice Address - Country:US
Practice Address - Phone:408-935-9120
Practice Address - Fax:408-935-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY490203336C0003X
CA3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5631963OtherNCPDP PROVIDER IDENTIFICATION NUMBER