Healthcare Provider Details

I. General information

NPI: 1962061648
Provider Name (Legal Business Name): WALNUT CREEK RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LA CASA VIA STE 100
WALNUT CREEK CA
94598-3016
US

IV. Provider business mailing address

112 LA CASA VIA STE 100
WALNUT CREEK CA
94598-3016
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-6311
  • Fax: 925-939-5639
Mailing address:
  • Phone: 925-939-6311
  • Fax: 925-939-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. PRATAP K ANNE
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 209-298-1715