Shasta Lake Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

51277 Issued in CA

Legal business name

SHASTA LAKE DRUG STORE INC

Doing business as

Shasta Lake Drug Store

Practice address

4222 Shasta Dam Blvd
Shasta Lake, CA 96019-9422

Phone

(530) 275-2700

Fax

(530) 275-2800

NPI assigned

Jul 10, 2013

Organization subpart

No

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

Authorized official

Name

Jodi Walsh

Title

Officer/Secretary

Phone

(530) 339-1445

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Shasta Lake Drug Store Doing business as

Locations

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

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375315200000",
    "number": "1568803260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 991179",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960991179",
            "telephone_number": "530-275-2700",
            "fax_number": "530-275-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4222 SHASTA DAM BLVD",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199422",
            "telephone_number": "530-275-2700",
            "fax_number": "530-275-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASTA LAKE DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-10",
        "last_updated": "2013-08-01",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "OFFICER/SECRETARY",
        "authorized_official_telephone_number": "530-339-1445"
    },
    "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": "51277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2138099",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA512770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shasta Lake Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Redding Rancheria
• Gloria Richmond, LMFT
• Ronald G Chambers Inc
• Shasta Community Health Center
• Shasta Lake Chiropractic
• Shasta Lake Physical Therapy
• Wallace Jay Spinks
• Steve Swirsky
• The Cornerstone Recovery Systems, Inc.
• Thrifty Payless Inc

• Community/Retail Pharmacy in Shasta Lake, CA
• Providers in Shasta Lake, 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 Aug 1, 2013; 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.