MEDICARE: 4TH STREET 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	3336C0003X	Community/Retail Pharmacy	50831	CA

General Provider Information

NPI Number	:	1265795447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4TH STREET PHARMACY, INC

Provider Business Mailing Address
First Line	:	1765 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2670
Country	:	US
Telephone Number	:	619-398-1800
Fax Number	:	619-481-3733

Provider Business Practice Location Address
First Line	:	1765 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2670
Country	:	US
Telephone Number	:	619-398-1800
Fax Number	:	619-481-3733

Authorized Official
Title or Position	:	OWNER/PIC
Name	:	MR. JOSEPH GRASELA
Credential	:	RPH
Telephone Number	:	619-683-2005

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

Similar Medicare Providers

1750458212 — LISA JANE CLEAVINGER MFT
Practice Location Address:

3853 ROSECRANS ST.
SAN DIEGO, CA
92110-2670

Practice Phone: 619-692-8275
Practice Fax: 619-692-8315

1750417952 — MS. KIM CHRISTINE ROSER-KEDWARD LCSW
Practice Location Address:

4075 PARK BLVD , STE 102-212
SAN DIEGO, CA
92103-2670

Practice Phone: 619-379-7450
Practice Fax:

1265947790 — HUMAM ALWAN
Practice Location Address:

11055 WEATHERWOOD TER
SAN DIEGO, CA
92131-2670

Practice Phone: 858-267-9994
Practice Fax:

1326553868 — INTULIFE
Practice Location Address:

11055 WEATHERWOOD TER
SAN DIEGO, CA
92131-2670

Practice Phone: 858-267-9994
Practice Fax:

1609414242 — DR. LAURA BETH FITZPATRICK PSYD
Practice Location Address:

4075 PARK BLVD STE 102-152
SAN DIEGO, CA
92103-2670

Practice Phone: 858-215-2545
Practice Fax:

1730710567 — INSPIRED PSYCHOLOGY INC
Practice Location Address:

4075 PARK BLVD STE 102-152
SAN DIEGO, CA
92103-2670

Practice Phone: 858-215-2545
Practice Fax:

Directions to “4TH STREET PHARMACY, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.