Provider Demographics
NPI:1215255666
Name:CHOICECARE PHARMACY
Entity type:Organization
Organization Name:CHOICECARE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALINIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-872-2261
Mailing Address - Street 1:90 S SPRUCE AVE STE W
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4555
Mailing Address - Country:US
Mailing Address - Phone:650-872-2261
Mailing Address - Fax:650-872-1069
Practice Address - Street 1:90 S SPRUCE AVE STE W
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4555
Practice Address - Country:US
Practice Address - Phone:650-872-2261
Practice Address - Fax:650-872-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501933336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125367OtherPK