MEDICARE: PRESCRIPTION HEADQUARTERS 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	333600000X	Pharmacy
2	3336M0002X	Mail Order Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY51910	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2148024	OTHER		PK

General Provider Information

NPI Number	:	1831104470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCRIPTION HEADQUARTERS INC

Provider Business Mailing Address
First Line	:	1340 TULLY RD
Second Line	:	STE 312
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3055
Country	:	US
Telephone Number	:	408-277-0160
Fax Number	:	408-277-0434

Provider Business Practice Location Address
First Line	:	1340 TULLY RD
Second Line	:	STE 312
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3055
Country	:	US
Telephone Number	:	408-277-0160
Fax Number	:	408-277-0434

Authorized Official
Title or Position	:	PRESIDENT/PIC
Name	:	NEEL KAMAL
Credential	:	PHARM D.
Telephone Number	:	408-277-0160

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/06/2021

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