Provider Demographics
NPI:1730231895
Name:TONY G BASTIAN PHARMACY INC.
Entity type:Organization
Organization Name:TONY G BASTIAN PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:415-751-2326
Mailing Address - Street 1:5199 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2815
Mailing Address - Country:US
Mailing Address - Phone:415-751-2326
Mailing Address - Fax:415-751-2328
Practice Address - Street 1:5199 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2815
Practice Address - Country:US
Practice Address - Phone:415-751-2326
Practice Address - Fax:415-751-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY32668333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GM583AMedicare PIN
0271560001Medicare NSC