Healthcare Provider Details

I. General information

NPI: 1992817027
Provider Name (Legal Business Name): CENTRAL DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 MISSION ST
SAN FRANCISCO CA
94112-1950
US

IV. Provider business mailing address

4494 MISSION ST
SAN FRANCISCO CA
94112-1950
US

V. Phone/Fax

Practice location:
  • Phone: 415-585-0111
  • Fax: 415-585-9006
Mailing address:
  • Phone: 415-585-0111
  • Fax: 415-585-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38147
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JERROLD STEVEN TONELLI
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 415-585-0111