MEDICARE: ZINFANDEL 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	305S00000X	Point of Service	PHY46527	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730185828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZINFANDEL PHARMACY INC

Provider Business Mailing Address
First Line	:	1995 ZINFANDEL DR
Second Line	:	STE 101
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-2862
Country	:	US
Telephone Number	:	916-631-4440
Fax Number	:	916-635-1024

Provider Business Practice Location Address
First Line	:	1995 ZINFANDEL DR
Second Line	:	STE 101
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-2862
Country	:	US
Telephone Number	:	916-631-4440
Fax Number	:	916-635-1024

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MRS. KIM N. PHAM
Credential	:	PHARM D
Telephone Number	:	916-631-4440

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/22/2020

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Directions to “ZINFANDEL PHARMACY INC ” Practice Location

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