Provider Demographics
NPI:1356570170
Name:DE ANZA VIEW PHARMACY INC
Entity type:Organization
Organization Name:DE ANZA VIEW PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-268-1660
Mailing Address - Street 1:7655 CLAIREMONT MESA BLVD
Mailing Address - Street 2:#306
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1512
Mailing Address - Country:US
Mailing Address - Phone:858-268-1660
Mailing Address - Fax:858-268-1661
Practice Address - Street 1:7655 CLAIREMONT MESA BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1517
Practice Address - Country:US
Practice Address - Phone:858-268-1660
Practice Address - Fax:858-268-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY539153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121120OtherPK
CA1356570170Medicaid
2121120OtherPK