Provider Demographics
NPI:1699820589
Name:HORSNYDER PHARMACY INC
Entity Type:Organization
Organization Name:HORSNYDER PHARMACY INC
Other - Org Name:HORSNYDER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-423-2315
Mailing Address - Street 1:1226 SOQUEL AVE STE A
Mailing Address - Street 2:STE A
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2157
Mailing Address - Country:US
Mailing Address - Phone:831-423-2315
Mailing Address - Fax:831-423-2320
Practice Address - Street 1:1226 SOQUEL AVE STE A
Practice Address - Street 2:STE A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2157
Practice Address - Country:US
Practice Address - Phone:831-423-2315
Practice Address - Fax:831-423-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
CAPHY518603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA51860Medicaid
2146447OtherPK
CAPHA51860Medicaid