Active NPI
Parkwoods Drug
- Community/Retail Pharmacy
- Stockton, CA
National Provider Identifier
1114078110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY46901
- Legal business name
- PARKWOODS DRUG
- Practice address
- 104 Lincoln Ctr
Stockton, CA 95207 - Phone
- (209) 475-1008
- Fax
- (209) 475-1027
- NPI assigned
- Jan 16, 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 Peters
- Title
- PHRM
- Phone
- (209) 475-1008
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY46901 | CA | Primary |
Addresses
Primary practice location
104 Lincoln Ctr
Stockton, CA 95207
Mailing address
104 Lincoln Ctr
Stockton, CA 95207
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5614323 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 5614323 | Other | OTHER ID NUMBER | |
| PHA46901 | Medicaid | CA |
National Provider Directory
National Provider Directory- Tax ID family
- Country Club Drug Store
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Valley Springs, CA
- NPI 1720244353
Locations
104 Lincoln Ctr
Stockton, CA 95207
Phone (209) 956-4949
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1185408000000",
"number": "1114078110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 LINCOLN CTR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 LINCOLN CTR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95207",
"telephone_number": "209-475-1008",
"fax_number": "209-475-1027"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PARKWOODS DRUG",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-26",
"status": "A",
"authorized_official_last_name": "PETERS",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "PHRM",
"authorized_official_telephone_number": "209-475-1008"
},
"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": "PHY46901",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "5614323",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER",
"identifier": "5614323",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PHA46901",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}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 Jul 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.