Provider Demographics
NPI:1437242831
Name:THOUSAND CRANES PHARMACY INC
Entity type:Organization
Organization Name:THOUSAND CRANES PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:TOSHIRO
Authorized Official - Last Name:MATSUNO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:415-409-4357
Mailing Address - Street 1:1832 BUCHANAN ST
Mailing Address - Street 2:#203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3252
Mailing Address - Country:US
Mailing Address - Phone:415-409-4357
Mailing Address - Fax:415-409-4355
Practice Address - Street 1:1832 BUCHANAN ST
Practice Address - Street 2:#203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3252
Practice Address - Country:US
Practice Address - Phone:415-409-4357
Practice Address - Fax:415-409-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA463020Medicaid
CA0590566OtherNCPDP
CA59193OtherPHARMACY LICENSE
CAPHA463020Medicaid