Active NPI
Pansmart Inc
Doing business as Tully Medical Clinic Pharmacy
- Community/Retail Pharmacy
- San Jose, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 51483
- Legal business name
- PANSMART INC
- Doing business as
- Tully Medical Clinic Pharmacy
- Practice address
- 1693 Flanigan Dr
104
San Jose, CA 95121-1683 - Phone
- (408) 274-6698
- Fax
- (408) 274-8580
- NPI assigned
- May 24, 2013
- Last updated
- May 24, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Pinak Gandhi
- Title
- Ceo
- Phone
- (408) 396-9200
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 51483 | CA | Primary |
Addresses
Primary practice location
1693 Flanigan Dr
104
San Jose, CA 95121-1683
Mailing address
1693 Flanigan Dr
104
San Jose, CA 95121-1683
Phone (408) 274-6698
Other names 1
- Tully Medical Clinic Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131115000684 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355577693 | Practice locations: San Jose, CA |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider DirectoryPractitioners & 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.
-
- Pharmacist
- San Jose, CA
- NPI 1972889244
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369353600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1369353600000",
"number": "1407293830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1693 FLANIGAN DR",
"address_2": "104",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951211683",
"telephone_number": "408-274-6698",
"fax_number": "408-274-8580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1693 FLANIGAN DR",
"address_2": "104",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951211683",
"telephone_number": "408-274-6698",
"fax_number": "408-274-8580"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PANSMART INC",
"organizational_subpart": "NO",
"enumeration_date": "2013-05-24",
"last_updated": "2013-05-24",
"status": "A",
"authorized_official_last_name": "GANDHI",
"authorized_official_first_name": "PINAK",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "408-396-9200"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "51483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Tully Medical Clinic Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; 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.