MEDICARE: HAPPELLS PHARMACY

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY45684	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0509440	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0509440	OTHER	OTHER ID NUMBER

General Provider Information

NPI Number	:	1326183955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPELLS PHARMACY

Provider Business Mailing Address
First Line	:	1530 WATERLOO RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95205-3738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 WATERLOO RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95205-3738
Country	:	US
Telephone Number	:	209-466-2522
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL CASTAGNO
Credential	:
Telephone Number	:	209-466-2522

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	09/12/2007

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Practice Location Address:

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1144764390 — NICOLE RANE COWAN
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1659342905 — DR. GARY F MALET D.O.
Practice Location Address:

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Directions to “HAPPELLS PHARMACY ” Practice Location

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