Provider Demographics
NPI: | 1457892747 |
---|---|
Name: | ROMIE LANE PHARMACY INC |
Entity Type: | Organization |
Organization Name: | ROMIE LANE PHARMACY INC |
Other - Org Name: | STAR PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER/PIC |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RUSSELL |
Authorized Official - Middle Name: | JOHN |
Authorized Official - Last Name: | OSTARELLO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 831-424-0395 |
Mailing Address - Street 1: | 1273 S MAIN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | SALINAS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93901-2185 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 831-424-0395 |
Mailing Address - Fax: | 831-424-7949 |
Practice Address - Street 1: | 1273 S MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | SALINAS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93901-2185 |
Practice Address - Country: | US |
Practice Address - Phone: | 831-424-0395 |
Practice Address - Fax: | 831-424-7949 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-03-20 |
Last Update Date: | 2017-03-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PHY54665 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |