Provider Demographics
NPI:1538102892
Name:TOWIN PHARMACY INC
Entity Type:Organization
Organization Name:TOWIN PHARMACY INC
Other - Org Name:PINE CONE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & PIC
Authorized Official - Prefix:
Authorized Official - First Name:THANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:916-580-5839
Mailing Address - Street 1:19660 STATE HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95665-9458
Mailing Address - Country:US
Mailing Address - Phone:209-296-8777
Mailing Address - Fax:209-296-8778
Practice Address - Street 1:19660 STATE HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:CA
Practice Address - Zip Code:95665-9458
Practice Address - Country:US
Practice Address - Phone:209-296-8777
Practice Address - Fax:209-296-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY537073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1997144OtherPK
CAPHA474010Medicaid
5664310001Medicare NSC