Provider Demographics
NPI:1558456988
Name:ROMIE LANE PHARMACY, INC
Entity type:Organization
Organization Name:ROMIE LANE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OSTARELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:831-424-0395
Mailing Address - Street 1:505 E ROMIE LN
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4031
Mailing Address - Country:US
Mailing Address - Phone:831-424-0395
Mailing Address - Fax:831-424-7949
Practice Address - Street 1:505 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4031
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:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY456423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA456420Medicaid
CAPHA456420Medicaid