=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265629802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMACIA REMEDIOS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2007
-----------------------------------------------------
Last Update Date | 10/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 996 S KING RD
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95116-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-251-8300
-----------------------------------------------------
Fax | 408-251-8300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9830
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84109-9830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-540-4748
-----------------------------------------------------
Fax | 801-716-4872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | BEN SINGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-377-5525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY48727
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------