=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275794307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-CITY PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2008
-----------------------------------------------------
Last Update Date | 08/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1132 CADILLAC CT
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-3058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-935-9120
-----------------------------------------------------
Fax | 408-935-9121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1132 CADILLAC CT
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-3058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-935-9120
-----------------------------------------------------
Fax | 408-935-9121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MIRANDA BASRAI
-----------------------------------------------------
Credential | PHARM. D
-----------------------------------------------------
Telephone | 510-366-9218
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY49020
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------