Healthcare Provider Details

I. General information

NPI: 1215255666
Provider Name (Legal Business Name): CHOICECARE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 S SPRUCE AVE STE W
SOUTH SAN FRANCISCO CA
94080-4555
US

IV. Provider business mailing address

90 S SPRUCE AVE STE W
SOUTH SAN FRANCISCO CA
94080-4555
US

V. Phone/Fax

Practice location:
  • Phone: 650-872-2261
  • Fax: 650-872-1069
Mailing address:
  • Phone: 650-872-2261
  • Fax: 650-872-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50193
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAROL MALINIS
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 650-872-2261