Provider Demographics
NPI:1306366950
Name:CGM PHARMACY CORPORATION
Entity Type:Organization
Organization Name:CGM PHARMACY CORPORATION
Other - Org Name:BLUE OAKS LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GLORY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-771-4778
Mailing Address - Street 1:1340 BLUE OAKS BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-7038
Mailing Address - Country:US
Mailing Address - Phone:916-771-4778
Mailing Address - Fax:916-771-0492
Practice Address - Street 1:1340 BLUE OAKS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-7038
Practice Address - Country:US
Practice Address - Phone:916-771-4778
Practice Address - Fax:916-771-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY551123336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy