Provider Demographics
NPI:1659305951
Name:PHARMACIA INC
Entity Type:Organization
Organization Name:PHARMACIA INC
Other - Org Name:1800 SULLIVAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:650-756-1800
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2227
Mailing Address - Country:US
Mailing Address - Phone:650-756-1800
Mailing Address - Fax:650-756-1313
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:650-756-1800
Practice Address - Fax:650-756-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY187843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA187840Medicaid
CA0554178OtherNAPB