NPIMap

Organization Active NPI

Mount Shasta Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Mount Shasta, CA
National Provider Identifier
1295494904
Registry record updated Dec 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MOUNT SHASTA PHARMACY, INC.
Practice address
148 Morgan Way
Mount Shasta, CA 96067
Phone
(530) 567-0270
NPI assigned
Dec 9, 2021
Last updated
Dec 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2021

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

Authorized official

Name
Tony IbrahimNPI 1336453117
Title
Ceo/Cfo/Director
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
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

148 Morgan Way
Mount Shasta, CA 96067

Mailing address

148 Morgan Way
Mount Shasta, CA 96067

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.

Locations

148 Morgan Way
Mount Shasta, CA 96067
Phone (530) 567-0270

Practitioners & affiliated clinicians

Practitioners 1

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": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639008000000",
    "number": "1295494904",
    "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"
        },
        {
            "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": "530-567-0270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT SHASTA PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-03",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CEO/CFO/DIRECTOR",
        "authorized_official_telephone_number": "760-987-6796"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 9, 2021; 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.