Olivehurst Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY48813 Issued in CA

Legal business name

OLIVEHURST DRUG STORE INC

Practice address

4897 Olivehurst Ave
Olivehurst, CA 95961-4225

Phone

(530) 743-5451

Fax

(530) 743-3713

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Hector Camacho, RPHNPI 1194306035

Title

Owner/Pic

Phone

(530) 743-5451

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• OLIVEHURST DRUG STORE Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hector Camacho, PHARM D

  • Pharmacist
  • Olivehurst, CA
  • NPI 1194306035
  NPD Authorized official

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490659200000",
    "number": "1255464871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4897 OLIVEHURST AVE",
            "address_2": "PO BOX 720",
            "city": "OLIVEHURST",
            "state": "CA",
            "postal_code": "959614225",
            "telephone_number": "530-743-5431",
            "fax_number": "530-743-3731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4897 OLIVEHURST AVE",
            "city": "OLIVEHURST",
            "state": "CA",
            "postal_code": "959614225",
            "telephone_number": "530-743-5451",
            "fax_number": "530-743-3713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVEHURST DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2017-03-28",
        "status": "A",
        "authorized_official_last_name": "CAMACHO",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "530-743-5451",
        "authorized_official_credential": "RPH"
    },
    "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": "PHY48813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2066990",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OLIVEHURST DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mario Gonzales Mendoza, TECHNICIAN
• Rosa Isabel Miramontes, CCMA
• Mariana Alejandra Mosqueda
• MP Pharmacy 2 Corp
• Melanie S. Myles, PT
• Jami Lee Orr
• Judith Pascual
• Peach Tree Healthcare
• Peach Tree Healthcare
• Peach Tree Healthcare

• All providers in Olivehurst, CA
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.