Active NPI
Dameron Hospital Association
- Community/Retail Pharmacy
- Stockton, CA
National Provider Identifier
1073663431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY39485
- Legal business name
- DAMERON HOSPITAL ASSOCIATION
- Doing business as
- DAMERONS LINACIA PHARMACY
- Practice address
- 420 W Acacia St
Stockton, CA 95203-2441 - Phone
- (209) 466-2954
- Fax
- (209) 466-1558
- NPI assigned
- Jan 10, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael Glasberg, B.S. PHARM
- Title
- Sr VP, Coo
- Phone
- (209) 944-5550
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY39485 | CA | Primary |
Addresses
Primary practice location
420 W Acacia St
Stockton, CA 95203-2441
Mailing address
420 W Acacia St
Stockton, CA 95203-2441
Phone (209) 466-2954
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHA 394850 | Medicaid | CA | |
| 2077836 | Other | PK |
Other names 1
- DAMERONS LINACIA PHARMACY
National Provider Directory
National Provider Directory- Tax ID family
- Dameron Hosp Pulm Function
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Stockton, CA
- NPI 1649321274
-
- Occupational Medicine Clinic/Center
- Stockton, CA
- NPI 1841340155
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1443484800000",
"number": "1073663431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 W ACACIA ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952032441",
"telephone_number": "209-466-2954",
"fax_number": "209-466-1558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W ACACIA ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952032441",
"telephone_number": "209-466-2954",
"fax_number": "209-466-1558"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DAMERON HOSPITAL ASSOCIATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-10",
"last_updated": "2015-09-29",
"status": "A",
"authorized_official_last_name": "GLASBERG",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "SR VP, COO",
"authorized_official_telephone_number": "209-944-5550",
"authorized_official_credential": "B.S. PHARM"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY39485",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PHA 394850",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2077836",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "DAMERONS LINACIA PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.