Provider Demographics
NPI:1629288188
Name:SAREEN PHARMACY INC.
Entity Type:Organization
Organization Name:SAREEN PHARMACY INC.
Other - Org Name:CARRANZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MANPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-883-4911
Mailing Address - Street 1:2600 MITCHELL RD.
Mailing Address - Street 2:SUITE G
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307
Mailing Address - Country:US
Mailing Address - Phone:209-883-4911
Mailing Address - Fax:209-883-0502
Practice Address - Street 1:2431 3RD. ST.
Practice Address - Street 2:
Practice Address - City:HUGHSON
Practice Address - State:CA
Practice Address - Zip Code:95326
Practice Address - Country:US
Practice Address - Phone:209-883-4911
Practice Address - Fax:209-883-0502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARRANZA PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY485483336C0003X
CAPHY561323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA485480Medicaid
CA6007240001Medicare NSC