Provider Demographics
NPI:1811674765
Name:FARMACIA SAN JOSE
Entity type:Organization
Organization Name:FARMACIA SAN JOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:PATRICELLI-ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:323-804-2034
Mailing Address - Street 1:6012 FLORENCE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4737
Mailing Address - Country:US
Mailing Address - Phone:562-659-7376
Mailing Address - Fax:
Practice Address - Street 1:6012 FLORENCE AVE STE D
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4737
Practice Address - Country:US
Practice Address - Phone:562-659-7376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy