Healthcare Provider Details

I. General information

NPI: 1942200142
Provider Name (Legal Business Name): ANDERSON BROTHERS FLORIN SQUARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2374 FLORIN RD
SACRAMENTO CA
95822-4403
US

IV. Provider business mailing address

2374 FLORIN RD
SACRAMENTO CA
95822-4403
US

V. Phone/Fax

Practice location:
  • Phone: 916-428-3794
  • Fax: 916-428-0259
Mailing address:
  • Phone: 916-428-3794
  • Fax: 916-428-0259

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 NumberPHY20884
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN ANDERSON
Title or Position: PHARMACIST
Credential:
Phone: 916-428-3794