Provider Demographics
NPI:1851463657
Name:RELIANCE CASTLE PHARMACY LLC
Entity Type:Organization
Organization Name:RELIANCE CASTLE PHARMACY LLC
Other - Org Name:CASTLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NEELMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-723-1888
Mailing Address - Street 1:3605 HOSPITAL ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5173
Mailing Address - Country:US
Mailing Address - Phone:209-723-1888
Mailing Address - Fax:209-723-1858
Practice Address - Street 1:3605 HOSPITAL ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5173
Practice Address - Country:US
Practice Address - Phone:209-723-1888
Practice Address - Fax:209-723-1858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANCE CASTLE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 506663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851463657Medicaid
5624502OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHY 50666OtherCALIFORNIA STATE BOARD OF PHARMACY