MEDICARE: S4 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		CA

General Provider Information

NPI Number	:	1346769395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S4 PHARMACY INC

Provider Business Mailing Address
First Line	:	3130 ALUM ROCK AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-2901
Country	:	US
Telephone Number	:	408-929-2210
Fax Number	:	408-929-2240

Provider Business Practice Location Address
First Line	:	3130 ALUM ROCK AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-2901
Country	:	US
Telephone Number	:	408-929-2210
Fax Number	:	408-929-2240

Authorized Official
Title or Position	:	PRESIDENT/PIC
Name	:	MRS. SHALINI MUPPALANENI
Credential	:	RPH
Telephone Number	:	708-929-2210

Provider Enumeration Date	:	09/11/2017
Last Update Date	:	07/21/2022

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Directions to “S4 PHARMACY INC ” Practice Location

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