Provider Demographics
NPI:1649260217
Name:TAKEMOTO DRUG CO
Entity type:Organization
Organization Name:TAKEMOTO DRUG CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKEMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:916-652-7265
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-0552
Mailing Address - Country:US
Mailing Address - Phone:916-652-7265
Mailing Address - Fax:916-652-8731
Practice Address - Street 1:3685 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650
Practice Address - Country:US
Practice Address - Phone:916-652-7265
Practice Address - Fax:916-652-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY170863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA170860Medicaid
0535003OtherOTHER ID NUMBER
CAPHA170860Medicaid