Basic Information
| Provider Information | |||||||||
| NPI: | 1114974797 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHARMACY ALTERNATIVES CALIFORNIA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COTTONWOOD DRUGS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 N WHITTINGTON PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402227101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023942100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20635 GAS POINT RD | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303473721 | ||||||||
| FaxNumber: | 5303470456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5023942100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | PHY43430 | CA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | PHY47451 | CA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BX2000X | PHY43430 | CA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 3336C0003X | PHY43430 | CA | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336I0012X | PHY47451 | CA | N | Suppliers | Pharmacy | Institutional Pharmacy | 3336L0003X | PHY43430 | CA | N | Suppliers | Pharmacy | Long Term Care Pharmacy | 3336M0002X | PHY43430 | CA | N | Suppliers | Pharmacy | Mail Order Pharmacy | 3336M0002X | PHY47451 | CA | N | Suppliers | Pharmacy | Mail Order Pharmacy | 3336M0003X | PHY4340 | CA | N | Suppliers | Pharmacy | Managed Care Organization Pharmacy | 335E00000X | PHY43430 | CA | N | Suppliers | Prosthetic/Orthotic Supplier | 335E00000X | PHY 47451 | CA | N | Suppliers | Prosthetic/Orthotic Supplier | 333600000X | PHY47451 | CA | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | PHA434300 | 05 | CA | MEDICAID | 0530938 | 01 | CA | NCPDP | OTHER | FP8236881 | 01 | CA | US DOJ | OTHER | PHY57109 | 01 | CA | BOARD OF PHARMACY | OTHER |