Provider Demographics
NPI:1285259473
Name:ADVANCE SJ PHARMACY, INC
Entity type:Organization
Organization Name:ADVANCE SJ PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:408-449-5755
Mailing Address - Street 1:2331A MONTPELIER DR STE A-10
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1614
Mailing Address - Country:US
Mailing Address - Phone:408-449-5755
Mailing Address - Fax:408-484-6379
Practice Address - Street 1:2331A MONTPELIER DR STE A-10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1614
Practice Address - Country:US
Practice Address - Phone:408-449-5755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy