Provider Demographics
NPI:1720449267
Name:HOT SPRINGS PHARMACY INC
Entity Type:Organization
Organization Name:HOT SPRINGS PHARMACY INC
Other - Org Name:HOT SPRINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / PIC / OWNER / AO
Authorized Official - Prefix:
Authorized Official - First Name:MARKO
Authorized Official - Middle Name:
Authorized Official - Last Name:FAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-251-2222
Mailing Address - Street 1:13313 PALM DR STE A
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-5980
Mailing Address - Country:US
Mailing Address - Phone:760-251-2222
Mailing Address - Fax:760-251-1200
Practice Address - Street 1:13313 PALM DR STE A
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-5980
Practice Address - Country:US
Practice Address - Phone:760-251-2222
Practice Address - Fax:760-251-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CAPHY543793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158742OtherPK