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General NPI Number Information
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NPI Number | 1982745154
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Entity Type | Organization
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Legal Business Name | MARIPOSA DRUG CO INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5034 HWY 140 6TH & CHARLES ST
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City | MARIPOSA
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State | CA
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Zip | 95338
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Country | US
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Telephone | 209-966-3315
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Fax | 209-966-6131
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Provider Business Mailing Address
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Address Line | PO BOX 67
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City | MARIPOSA
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State | CA
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Zip | 95338-0067
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Country | US
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Telephone | 209-966-3315
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Fax | 209-966-6131
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MARK RADANOVICH
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Credential |
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Telephone | 209-966-3315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY10528
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License Number State | CA
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