Provider Demographics
NPI:1427428119
Name:MEADOWMONT PHARMACY
Entity type:Organization
Organization Name:MEADOWMONT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:209-795-1155
Mailing Address - Street 1:2182 HWY 4
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:CA
Mailing Address - Zip Code:95223
Mailing Address - Country:US
Mailing Address - Phone:209-795-6862
Mailing Address - Fax:
Practice Address - Street 1:2182 HIGHWAY 4
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:CA
Practice Address - Zip Code:95223-9908
Practice Address - Country:US
Practice Address - Phone:209-795-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty