Provider Demographics
NPI:1386649887
Name:ALUM ROCK PHARMACY INC
Entity Type:Organization
Organization Name:ALUM ROCK PHARMACY INC
Other - Org Name:ALUM ROCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:AN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:408-254-1551
Mailing Address - Street 1:1855 ALUM ROCK AVE
Mailing Address - Street 2:STE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1398
Mailing Address - Country:US
Mailing Address - Phone:408-254-1551
Mailing Address - Fax:408-254-3099
Practice Address - Street 1:1855 ALUM ROCK AVE
Practice Address - Street 2:STE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1398
Practice Address - Country:US
Practice Address - Phone:408-254-1551
Practice Address - Fax:408-254-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY514503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140895OtherPK
CAPHY49179Medicaid