Provider Demographics
NPI:1831259589
Name:CALI PHARMACY
Entity type:Organization
Organization Name:CALI PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:PHI
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-275-0858
Mailing Address - Street 1:702 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1920
Mailing Address - Country:US
Mailing Address - Phone:408-275-0858
Mailing Address - Fax:408-275-0859
Practice Address - Street 1:702 E SANTA CLARA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1920
Practice Address - Country:US
Practice Address - Phone:408-275-0858
Practice Address - Fax:408-275-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA438820Medicaid