Provider Demographics
NPI:1649312174
Name:PACE ZONE PHARMACY
Entity type:Organization
Organization Name:PACE ZONE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRATAP
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-298-1715
Mailing Address - Street 1:407 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571
Mailing Address - Country:US
Mailing Address - Phone:707-374-5135
Mailing Address - Fax:707-374-5408
Practice Address - Street 1:407 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571
Practice Address - Country:US
Practice Address - Phone:707-374-5135
Practice Address - Fax:707-374-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA58700OtherPHARMACY LICENSE
FD1980829OtherDEA LICENSE
CAPHA223170Medicaid
CA6047100001Medicare NSC