Provider Demographics
NPI:1376524025
Name:CEDAR PHARMACY INC
Entity Type:Organization
Organization Name:CEDAR PHARMACY INC
Other - Org Name:CEDAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-536-7799
Mailing Address - Street 1:10737 CAMINO RUIZ
Mailing Address - Street 2:#138
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126
Mailing Address - Country:US
Mailing Address - Phone:858-536-7799
Mailing Address - Fax:858-536-7716
Practice Address - Street 1:10737 CAMINO RUIZ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2361
Practice Address - Country:US
Practice Address - Phone:858-536-7799
Practice Address - Fax:858-536-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46203332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA462030Medicaid
CAPHA462030Medicaid