Provider Demographics
NPI:1265529028
Name:FAMILY DRUG INC.
Entity type:Organization
Organization Name:FAMILY DRUG INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PREDISENT BD. OF DIRECTORS
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-224-7807
Mailing Address - Street 1:592 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3611
Mailing Address - Country:US
Mailing Address - Phone:707-363-1607
Mailing Address - Fax:707-230-5566
Practice Address - Street 1:592 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3611
Practice Address - Country:US
Practice Address - Phone:707-363-1607
Practice Address - Fax:707-230-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0538439OtherNCPDP (NABP) NUMBER
CAPHA453930Medicaid
CAPHA453930Medicaid
CAPHA146610Medicare NSC