Provider Demographics
NPI:1952479602
Name:ST JAMES HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:ST JAMES HEALTH CENTER PHARMACY
Other - Org Name:ST JAMES HEALTH CENTER PHARMACY GARDNER FAMILY HEALTH NETWORK INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REYMUNDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-918-2682
Mailing Address - Street 1:55 EAST JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112
Mailing Address - Country:US
Mailing Address - Phone:408-918-2612
Mailing Address - Fax:408-280-0206
Practice Address - Street 1:55 EAST JULIAN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-918-2612
Practice Address - Fax:408-280-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34273333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0597584OtherNADP
CAPHA342730Medicaid