Provider Demographics
NPI:1528680014
Name:FAMILIA FARMACIA INC
Entity type:Organization
Organization Name:FAMILIA FARMACIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:OSEGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-566-9956
Mailing Address - Street 1:1757 CROWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-5608
Mailing Address - Country:US
Mailing Address - Phone:209-566-9956
Mailing Address - Fax:209-408-0609
Practice Address - Street 1:1757 CROWS LANDING RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-5608
Practice Address - Country:US
Practice Address - Phone:209-566-9956
Practice Address - Fax:209-408-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861965410Medicaid