Healthcare Provider Details

I. General information

NPI: 1649260217
Provider Name (Legal Business Name): TAKEMOTO DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 TAYLOR RD
LOOMIS CA
95650
US

IV. Provider business mailing address

PO BOX 552
LOOMIS CA
95650-0552
US

V. Phone/Fax

Practice location:
  • Phone: 916-652-7265
  • Fax: 916-652-8731
Mailing address:
  • Phone: 916-652-7265
  • Fax: 916-652-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY17086
License Number StateCA

VIII. Authorized Official

Name: GORDON TAKEMOTO
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 916-652-7265