Provider Demographics
NPI:1154408292
Name:DEMARTINI SPRING HILL PHARMACY INC.
Entity type:Organization
Organization Name:DEMARTINI SPRING HILL PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DEMARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:530-273-2268
Mailing Address - Street 1:102 CATHERINE LANE
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-273-2268
Mailing Address - Fax:530-273-0116
Practice Address - Street 1:102 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5701
Practice Address - Country:US
Practice Address - Phone:530-273-2268
Practice Address - Fax:530-273-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY215153336C0004X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA215150Medicaid
CAPHY 21515OtherPHARMACY LIC #
CA0533441OtherNABP
CA0533441OtherNABP
CAPHA215150Medicaid