Mother Lode Pharmacies, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

417030 Issued in CA

Legal business name

MOTHER LODE PHARMACIES, INC.

Doing business as

Kelly's Drug Store

Practice address

64 E. Saint Charles St
San Andreas, CA 95249-0009

Phone

(209) 754-3595

Fax

(209) 754-5387

NPI assigned

Oct 17, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Raymond L Guidi, RPH

Title

President

Phone

(209) 754-3595

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• KELLY'S DRUG STORE Doing business as

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891876918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 606",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952490606",
            "telephone_number": "209-754-3595",
            "fax_number": "209-754-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 E. SAINT CHARLES ST",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952490009",
            "telephone_number": "209-754-3595",
            "fax_number": "209-754-5387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOTHER LODE PHARMACIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUIDI",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-754-3595",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "417030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA417030",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KELLY'S DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Z Michnowska, M.D.
• Joana Codruta Mihaila-Motiu, DDS
• Heidi V Mitchem
• Jeadawn Mordwinow
• Susan Lee Morgan-Yount, ACSW
• Mountain Oak Health Centers
• Robert Kenneth Mulert, M.D.
• Zachery Richard Murton, MFT INTERN
• Debra Mutopo, FNP
• Melody W Nelson, MT-BC

• Pharmacy in San Andreas, CA
• Providers in San Andreas, CA by specialty
• Pharmacy in California

• 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.