=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699934703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PJ'S PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 11/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1180 LIVE OAK BLVD
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991-3407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-218-5696
-----------------------------------------------------
Fax | 530-870-8863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1180 LIVE OAK BLVD
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991-3407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-870-8405
-----------------------------------------------------
Fax | 530-870-8863
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | DR. PERMINDER SINGH DALE
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 530-218-5696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PENDING
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------