Provider Demographics
NPI:1710549506
Name:YOSEMITE DRUG
Entity Type:Organization
Organization Name:YOSEMITE DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:209-382-1291
Mailing Address - Street 1:35300 HIGHWAY 41 STE 101
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-8718
Mailing Address - Country:US
Mailing Address - Phone:559-692-2479
Mailing Address - Fax:
Practice Address - Street 1:35300 HIGHWAY 41 STE 101
Practice Address - Street 2:
Practice Address - City:COARSEGOLD
Practice Address - State:CA
Practice Address - Zip Code:93614-8718
Practice Address - Country:US
Practice Address - Phone:559-692-2479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN JOAQUIN DRUG INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy