Provider Demographics
NPI:1629105549
Name:EZSTEP INC
Entity Type:Organization
Organization Name:EZSTEP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KLUJ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:408-277-0562
Mailing Address - Street 1:1460 TULLY RD
Mailing Address - Street 2:604
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3059
Mailing Address - Country:US
Mailing Address - Phone:408-277-0562
Mailing Address - Fax:408-277-0592
Practice Address - Street 1:1460 TULLY RD
Practice Address - Street 2:604
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3059
Practice Address - Country:US
Practice Address - Phone:408-277-0562
Practice Address - Fax:408-277-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA039428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANBBPHA46990Medicaid
CAPHY46999OtherPHARMACY PERMIT NUMBER
CA5089580001Medicare ID - Type UnspecifiedMEDICARE ID NUMBER