NPIMap

Organization Active NPI

Mount Shasta Pharmacy, Inc.

Doing business as Mount Shasta Pharmacy

  • Long Term Care Pharmacy
  • Mount Shasta, CA
National Provider Identifier
1194506113
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
MOUNT SHASTA PHARMACY, INC.
Doing business as
Mount Shasta Pharmacy
Practice address
148 Morgan Way
Mount Shasta, CA 96067
Phone
(530) 568-0270
Fax
(530) 568-0271
NPI assigned
Oct 6, 2023
Last updated
Oct 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tony IbrahimNPI 1336453117
Title
Ceo
Phone
(760) 987-6796

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

148 Morgan Way
Mount Shasta, CA 96067

Mailing address

148 Morgan Way
Mount Shasta, CA 96067
Phone (530) 568-0270

Other names 1

  • Mount Shasta Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mount Shasta Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1194506113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 MORGAN WAY",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "96067",
            "telephone_number": "530-568-0270",
            "fax_number": "530-568-0271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 MORGAN WAY",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "96067",
            "telephone_number": "530-568-0270",
            "fax_number": "530-568-0271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT SHASTA PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-06",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-987-6796"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Shasta Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Shasta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.