Provider Demographics
NPI:1598192395
Name:ORDWAY PHARMACY
Entity type:Organization
Organization Name:ORDWAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHAMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TREMBLAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:508-463-6699
Mailing Address - Street 1:2256 CAPITOLA RD APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3144
Mailing Address - Country:US
Mailing Address - Phone:508-463-6699
Mailing Address - Fax:
Practice Address - Street 1:499 ALVARADO ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2739
Practice Address - Country:US
Practice Address - Phone:831-372-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA639423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy