Provider Demographics
NPI:1588729917
Name:D K DOKIMOS INC
Entity type:Organization
Organization Name:D K DOKIMOS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DOKIMOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:530-274-0100
Mailing Address - Street 1:640 E MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5854
Mailing Address - Country:US
Mailing Address - Phone:530-274-0100
Mailing Address - Fax:530-274-7500
Practice Address - Street 1:640 E MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5854
Practice Address - Country:US
Practice Address - Phone:530-274-0100
Practice Address - Fax:530-274-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CAPHY469633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588729917Medicaid
2113329OtherPK