Provider Demographics
NPI:1447584792
Name:EMPIRE DRUG COMPANY INC
Entity Type:Organization
Organization Name:EMPIRE DRUG COMPANY INC
Other - Org Name:FORESTVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-887-2260
Mailing Address - Street 1:6652 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9688
Mailing Address - Country:US
Mailing Address - Phone:707-887-2260
Mailing Address - Fax:707-887-0106
Practice Address - Street 1:6652 FRONT ST
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:CA
Practice Address - Zip Code:95436-9688
Practice Address - Country:US
Practice Address - Phone:707-887-2260
Practice Address - Fax:707-887-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA500313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121822OtherPK