Provider Demographics
NPI:1932374956
Name:CITY CENTER PHARMACY INC
Entity Type:Organization
Organization Name:CITY CENTER PHARMACY INC
Other - Org Name:CITY CENTER PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONSUELO
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-432-9770
Mailing Address - Street 1:1270 E LELAND RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5347
Mailing Address - Country:US
Mailing Address - Phone:925-432-9770
Mailing Address - Fax:925-432-9774
Practice Address - Street 1:1270 E LELAND RD
Practice Address - Street 2:STE 102
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5347
Practice Address - Country:US
Practice Address - Phone:925-432-9770
Practice Address - Fax:925-432-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA489813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113480OtherPK
CA1932374956Medicaid
6335040001Medicare NSC