Country Club Drug Store

LBN: Michael T Peters
Country Club Drug Store is an health care organization with primary practice located at 1919 Vista Del Lago Dr Ste 6, Valley Springs CA 95252-9294. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy, Suppliers / Mail Order Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Michael T Peters can be contacted via phone (209) 772-1633, or through Peters, Michael via phone (209) 473-1762.

Contact Information

Primary practice address
1919 Vista Del Lago Dr Ste 6 Valley Springs CA 95252-9294
Phone: (209) 772-1633
Fax: (209) 772-1676
Website:
Map and Directions
Authorized official contact:
Name: Peters, Michael
Phone: (209) 473-1762

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X PHY49019 California
Suppliers / Compounding Pharmacy 3336C0004X
Suppliers / Mail Order Pharmacy 3336M0002X

Profile Details

NPI number 1720244353
LBN Legal business name Michael T Peters
DBA Doing business as Country Club Drug Store
Authorized official Peters, Michael
Entity Organization
Organization subpart 1 No
Enumeration date Aug 4th, 2008
Last updated Jun 29th, 2009 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720244353 NPPES
Other 5631191 NCPDP PROVIDER IDENTIFICATION NUMBER

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