Provider Demographics
NPI:1992817811
Name:PRESCRIPTION STATION INC
Entity type:Organization
Organization Name:PRESCRIPTION STATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TULOD
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:760-241-3390
Mailing Address - Street 1:PO BOX 2909
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-2909
Mailing Address - Country:US
Mailing Address - Phone:760-241-3390
Mailing Address - Fax:760-241-5458
Practice Address - Street 1:15048 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3839
Practice Address - Country:US
Practice Address - Phone:760-241-3390
Practice Address - Fax:760-241-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY461033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA461030Medicaid
2116318OtherPK
CAPHA461030Medicaid