4TH Street Pharmacy, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

50831 Issued in CA

Legal business name

4TH STREET PHARMACY, INC

Practice address

1765 4TH Ave
San Diego, CA 92101-2670

Phone

(619) 398-1800

Fax

(619) 481-3733

NPI assigned

Jun 21, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Joseph Grasela, RPH

Title

Owner/Pic

Phone

(619) 683-2005

Specialties & licenses 1

Addresses

Other names 1

• University Compounding Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1340236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340236800000",
    "number": "1265795447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012670",
            "telephone_number": "619-398-1800",
            "fax_number": "619-481-3733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012670",
            "telephone_number": "619-398-1800",
            "fax_number": "619-481-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4TH STREET PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-21",
        "last_updated": "2012-06-21",
        "status": "A",
        "authorized_official_last_name": "GRASELA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "619-683-2005",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "50831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in San Diego, CA
• Providers in San Diego, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; 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.