Provider Demographics
NPI:1316768641
Name:YOUR DRUG STORE INC
Entity type:Organization
Organization Name:YOUR DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC, CORPORATE SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALTMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:661-325-2487
Mailing Address - Street 1:2303 NILES PT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4025
Mailing Address - Country:US
Mailing Address - Phone:661-325-2487
Mailing Address - Fax:661-325-0654
Practice Address - Street 1:2303 NILES PT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4025
Practice Address - Country:US
Practice Address - Phone:661-325-2487
Practice Address - Fax:661-325-0654
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR DRUG STORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy