Provider Demographics
NPI:1568842003
Name:STOCKTON DRUG
Entity Type:Organization
Organization Name:STOCKTON DRUG
Other - Org Name:GALT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/PIC
Authorized Official - Prefix:
Authorized Official - First Name:PRATAP
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-251-7535
Mailing Address - Street 1:1000 C ST
Mailing Address - Street 2:SUITE:35
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-1751
Mailing Address - Country:US
Mailing Address - Phone:209-251-7535
Mailing Address - Fax:209-251-7772
Practice Address - Street 1:1000 C ST
Practice Address - Street 2:SUITE:35
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-1751
Practice Address - Country:US
Practice Address - Phone:209-251-7535
Practice Address - Fax:209-251-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533443336L0003X, 3336L0003X, 3336L0003X
3336S0011X, 332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152306OtherPK
CAPHY 53344OtherPHARMACY LICENSE
CAPHY 53344OtherPHARMACY LICENSE