NPIMap

Organization Active NPI

Grant Line Pharmacy Inc

  • Community/Retail Pharmacy
  • Tracy, CA
National Provider Identifier
1386816205
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY48989 Issued in CA
Legal business name
GRANT LINE PHARMACY INC
Practice address
2160 W Grant Line Rd
Ste 205
Tracy, CA 95377-7330
Phone
(209) 832-2999
Fax
(209) 221-0909
NPI assigned
Apr 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Authorized official

Name
Beatle Tran, PHARMDNPI 1821081910
Title
Ceo/Pharmacist
Phone
(209) 832-2999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY48989 CA Primary

Addresses

Primary practice location

2160 W Grant Line Rd
Ste 205
Tracy, CA 95377-7330

Mailing address

2160 W Grant Line Rd
Ste 205
Tracy, CA 95377-7330
Phone (209) 832-2999

Other identifiers 2

IdentifierTypeStateIssuer
2113308OtherPK
1386816205MedicaidCA

Other names 1

  • GRANT LINE PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

2160 W Grant Line Rd
Ste 205
Tracy, CA 95377
Phone (209) 832-2999

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1386816205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 W GRANT LINE RD",
            "address_2": "STE 205",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777330",
            "telephone_number": "209-832-2999",
            "fax_number": "209-221-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 W GRANT LINE RD",
            "address_2": "STE 205",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777330",
            "telephone_number": "209-832-2999",
            "fax_number": "209-221-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT LINE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "BEATLE",
        "authorized_official_title_or_position": "CEO/PHARMACIST",
        "authorized_official_telephone_number": "209-832-2999",
        "authorized_official_credential": "PHARMD"
    },
    "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": "PHY48989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2113308",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386816205",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRANT LINE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; 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.