Healthcare Provider Details

I. General information

NPI: 1104807460
Provider Name (Legal Business Name): REPUBLIC PHARMACY CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 GRANT AVE
SAN FRANCISCO CA
94108-2114
US

IV. Provider business mailing address

704 GRANT AVE
SAN FRANCISCO CA
94108-2114
US

V. Phone/Fax

Practice location:
  • Phone: 415-982-8641
  • Fax:
Mailing address:
  • Phone: 415-982-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY694
License Number StateCA

VIII. Authorized Official

Name: WILLIAM WONG JR.
Title or Position: PRESIDENT
Credential:
Phone: 415-982-8641