Provider Demographics
NPI:1437242831
Name:THOUSAND CRANES PHARMACY INC
Entity Type:Organization
Organization Name:THOUSAND CRANES PHARMACY INC
Other - Org Name:THOUSAND CRANES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:MASUDA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:415-409-4357
Mailing Address - Street 1:1832 BUCHANAN ST
Mailing Address - Street 2:#203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3252
Mailing Address - Country:US
Mailing Address - Phone:415-409-4357
Mailing Address - Fax:415-409-4355
Practice Address - Street 1:1832 BUCHANAN ST
Practice Address - Street 2:#203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3252
Practice Address - Country:US
Practice Address - Phone:415-409-4357
Practice Address - Fax:415-409-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY463023336C0003X, 3336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0590566OtherNCPDP
CAPHY46302OtherPHARMACY LICENSE NO
CAPHA463020Medicaid
CAPHA463020Medicaid