MEDICARE: ANDERSON BROTHERS FLORIN SQUARE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	208840	CA

General Provider Information

NPI Number	:	1174040943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON BROTHERS FLORIN SQUARE PHARMACY INC

Provider Business Mailing Address
First Line	:	2374 FLORIN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2374 FLORIN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4403
Country	:	US
Telephone Number	:	916-428-3794
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	JOHN ANDERSON
Credential	:
Telephone Number	:	916-428-3796

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/23/2017

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