Provider Demographics
NPI:1184613051
Name:DREW CENTER PHARMACY
Entity type:Organization
Organization Name:DREW CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST IN C HARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:650-321-1449
Mailing Address - Street 1:P.O. BOX 51216
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303
Mailing Address - Country:US
Mailing Address - Phone:650-321-1449
Mailing Address - Fax:650-321-5977
Practice Address - Street 1:2242 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303
Practice Address - Country:US
Practice Address - Phone:650-321-1449
Practice Address - Fax:650-321-5977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184613051Medicaid
CAPHA223020OtherMEDI-CAL ID #
CAPHY57523OtherCAL PHARMACY LICENSE
CA0531524OtherNABP#
CA0531524OtherNABP#