MEDICARE: ADVANCE SJ 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

General Provider Information

NPI Number	:	1285259473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE SJ PHARMACY, INC

Provider Business Mailing Address
First Line	:	2331A MONTPELIER DR STE A-10
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1614
Country	:	US
Telephone Number	:	408-449-5755
Fax Number	:	408-484-6379

Provider Business Practice Location Address
First Line	:	2331A MONTPELIER DR STE A-10
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1614
Country	:	US
Telephone Number	:	408-449-5755
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	CATHY THAI
Credential	:	PHARMD
Telephone Number	:	408-449-5755

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	06/15/2022

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