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?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3440839OtherCA CORP