Provider Demographics
NPI:1447362363
Name:MED-ECON PHARMACY INC
Entity type:Organization
Organization Name:MED-ECON PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORI
Authorized Official - Middle Name:
Authorized Official - Last Name:YABUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:650-968-3535
Mailing Address - Street 1:105 SOUTH DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4311
Mailing Address - Country:US
Mailing Address - Phone:650-968-3535
Mailing Address - Fax:650-968-4620
Practice Address - Street 1:105 SOUTH DR
Practice Address - Street 2:STE 100
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4311
Practice Address - Country:US
Practice Address - Phone:650-968-3535
Practice Address - Fax:650-968-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY324733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0566628OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA324730Medicaid
1090930001Medicare NSC