Provider Demographics
NPI:1265699219
Name:SACTO PHARMACY
Entity type:Organization
Organization Name:SACTO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HUE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:916-454-0168
Mailing Address - Street 1:5033 STOCKTON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-5407
Mailing Address - Country:US
Mailing Address - Phone:916-454-0168
Mailing Address - Fax:916-454-5949
Practice Address - Street 1:5033 STOCKTON BOULEVARD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-5407
Practice Address - Country:US
Practice Address - Phone:916-454-0168
Practice Address - Fax:916-454-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY367743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA367740Medicaid