Provider Demographics
NPI:1518992031
Name:TOWER PHARMACY, INC.
Entity Type:Organization
Organization Name:TOWER PHARMACY, INC.
Other - Org Name:QUESENBERRYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:NELLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-874-2138
Mailing Address - Street 1:12641 BENTLEY ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95386-9011
Mailing Address - Country:US
Mailing Address - Phone:209-874-2138
Mailing Address - Fax:209-874-9853
Practice Address - Street 1:12641 BENTLEY ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CA
Practice Address - Zip Code:95386-9011
Practice Address - Country:US
Practice Address - Phone:209-874-2138
Practice Address - Fax:209-874-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY506243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY369720Medicaid
CAPHY369720Medicaid