=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548507999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER PLACER PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2013
-----------------------------------------------------
Last Update Date | 07/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3133 PROFESSIONAL DR STE 17
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95603-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-885-8582
-----------------------------------------------------
Fax | 530-885-8539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3133 PROFESSIONAL DR SUITE #17
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95603-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-885-8582
-----------------------------------------------------
Fax | 530-885-8593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HUYQUANG LE
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 530-885-8582
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 51180
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------