Provider Demographics
NPI:1942200142
Name:ANDERSON BROTHERS FLORIN SQUARE PHARMACY INC
Entity Type:Organization
Organization Name:ANDERSON BROTHERS FLORIN SQUARE PHARMACY INC
Other - Org Name:ANDERSON BROS FLORIN SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-428-3794
Mailing Address - Street 1:2374 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4403
Mailing Address - Country:US
Mailing Address - Phone:916-428-3794
Mailing Address - Fax:916-428-0259
Practice Address - Street 1:2374 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4403
Practice Address - Country:US
Practice Address - Phone:916-428-3794
Practice Address - Fax:916-428-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CAPHY208843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA208840Medicaid
1991816OtherPK
CAPHA208840Medicaid