Provider Demographics
NPI:1447288634
Name:SAN FRANCISCO GENERAL HOSPITAL OUTPATIENT PHARMACY
Entity type:Organization
Organization Name:SAN FRANCISCO GENERAL HOSPITAL OUTPATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:HOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:415-206-3265
Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-3265
Mailing Address - Fax:415-206-3800
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-3265
Practice Address - Fax:415-206-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHPE 17392333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHB173920Medicaid