Provider Demographics
NPI:1720153133
Name:SCV PHARMACEUTICALS INC.
Entity Type:Organization
Organization Name:SCV PHARMACEUTICALS INC.
Other - Org Name:WESTWOOD PRESCRIPTIONISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:DEMETRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:408-266-7000
Mailing Address - Street 1:1211 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5210
Mailing Address - Country:US
Mailing Address - Phone:408-266-7000
Mailing Address - Fax:408-266-1614
Practice Address - Street 1:1211 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5210
Practice Address - Country:US
Practice Address - Phone:408-266-7000
Practice Address - Fax:408-266-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASRGH 26-1027743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 199910Medicaid
054-6284OtherNABP
CAPHA 199910Medicaid