Provider Demographics
NPI:1437287802
Name:MEDICAL CENTER PHARMACIES INC
Entity Type:Organization
Organization Name:MEDICAL CENTER PHARMACIES INC
Other - Org Name:JEFFERSON PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MGR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PINGHON CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:650-366-3784
Mailing Address - Street 1:3137 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2959
Mailing Address - Country:US
Mailing Address - Phone:650-366-3784
Mailing Address - Fax:650-366-1848
Practice Address - Street 1:3137 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2959
Practice Address - Country:US
Practice Address - Phone:650-366-3784
Practice Address - Fax:650-366-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY110623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2076783OtherPK
CAPHA110620Medicaid
1202750001Medicare NSC