NPIMap

Organization Active NPI

Foothill Pharmacy Inc.

  • Community/Retail Pharmacy
  • Woodlake, CA
National Provider Identifier
1639205248
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY46418 Issued in CA
Legal business name
FOOTHILL PHARMACY INC.
Practice address
250 E Antelope Ave
Suite B
Woodlake, CA 93286-1585
Phone
(559) 564-7177
Fax
(559) 564-7104
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Steven Leigh Richmond, B.S.
Title
President
Phone
(559) 564-7177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHY46418 CA Primary

Addresses

Primary practice location

250 E Antelope Ave
Suite B
Woodlake, CA 93286-1585

Mailing address

250 E Antelope Ave
Suite B
Woodlake, CA 93286-1585
Phone (559) 564-7177

Other identifiers 2

IdentifierTypeStateIssuer
0563191OtherCANCPDP NUMBER
PHA464180MedicaidCA

Other names 1

  • JERRY'S DRUG Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Foothill Pharmacy Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

250 E Antelope Ave
Ste B
Woodlake, CA 93286
Phone (559) 564-7177

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639205248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E ANTELOPE AVE",
            "address_2": "SUITE B",
            "city": "WOODLAKE",
            "state": "CA",
            "postal_code": "932861585",
            "telephone_number": "559-564-7177",
            "fax_number": "559-564-7104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E ANTELOPE AVE",
            "address_2": "SUITE B",
            "city": "WOODLAKE",
            "state": "CA",
            "postal_code": "932861585",
            "telephone_number": "559-564-7177",
            "fax_number": "559-564-7104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILL PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICHMOND",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "559-564-7177",
        "authorized_official_credential": "B.S."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY46418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "0563191",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA464180",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JERRY'S DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodlake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.