=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780206557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEN ACRES PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2020
-----------------------------------------------------
Last Update Date | 11/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2930 FREEPORT BLVD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-730-2859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2562 SILVERADO ST
-----------------------------------------------------
City | WEST SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95691-6070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-730-2859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | DR. SONA BACA FRAUSTO
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 916-730-2859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------