Provider Demographics
NPI: | 1316204241 |
---|---|
Name: | AFP DRUGSTORE, INC. |
Entity Type: | Organization |
Organization Name: | AFP DRUGSTORE, INC. |
Other - Org Name: | A FAMILY PHARMACY APPLE VALLEY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TEKELE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 760-242-5452 |
Mailing Address - Street 1: | PO BOX 900 |
Mailing Address - Street 2: | |
Mailing Address - City: | VICTORVILLE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92393-0900 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 760-242-5452 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 15863 KASOTA RD |
Practice Address - Street 2: | SUITE C |
Practice Address - City: | APPLE VALLEY |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92307-4507 |
Practice Address - Country: | US |
Practice Address - Phone: | 760-242-5452 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-04-17 |
Last Update Date: | 2012-04-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 3440839 | Other | CA CORP |