MEDICARE: CALIFORMACY 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	PHY48917	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0530471	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1326150319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORMACY INC

Provider Business Mailing Address
First Line	:	3526 MANTHEY RD
Second Line	:	STE H
City	:	STOCKTON
State	:	CA
Zip	:	95206-5301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3526 MANTHEY RD
Second Line	:	STE H
City	:	STOCKTON
State	:	CA
Zip	:	95206-5301
Country	:	US
Telephone Number	:	209-234-1020
Fax Number	:	209-234-1825

Authorized Official
Title or Position	:	PRESIDNET
Name	:	VIVEK NAVANEETHAN
Credential	:
Telephone Number	:	209-234-1020

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/14/2008

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Directions to “CALIFORMACY INC ” Practice Location

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