Provider Demographics
NPI:1437689759
Name:THOUSAND CRANES PHARMACY INC
Entity Type:Organization
Organization Name:THOUSAND CRANES PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
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 STE 203
Mailing Address - Street 2:
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:
Practice Address - Street 1:1832 BUCHANAN ST STE 203
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOUSAND CRANES PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY463023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA463020Medicaid