Healthcare Provider Details

I. General information

NPI: 1154408292
Provider Name (Legal Business Name): DEMARTINI SPRING HILL PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CATHERINE LN
GRASS VALLEY CA
95945-5701
US

IV. Provider business mailing address

102 CATHERINE LANE
GRASS VALLEY CA
95945
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-2268
  • Fax: 530-273-5987
Mailing address:
  • Phone: 530-273-2268
  • Fax: 530-273-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY21515
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY21515
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID ALAN DEMARTINI
Title or Position: PRESIDENT
Credential: RPH
Phone: 530-273-2268