MEDICARE: ANDERSON BROTHERS FLORIN SQUARE 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	3336L0003X	Long Term Care Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY20884	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
2	1991816	OTHER		PK

General Provider Information

NPI Number	:	1942200142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON BROTHERS FLORIN SQUARE PHARMACY INC

Provider Business Mailing Address
First Line	:	2374 FLORIN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4403
Country	:	US
Telephone Number	:	916-428-3794
Fax Number	:	916-428-0259

Provider Business Practice Location Address
First Line	:	2374 FLORIN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4403
Country	:	US
Telephone Number	:	916-428-3794
Fax Number	:	916-428-0259

Authorized Official
Title or Position	:	PHARMACIST
Name	:	JOHN ANDERSON
Credential	:
Telephone Number	:	916-428-3794

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/13/2016

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