MOTHER LODE PHARMACIES INC. NPI 1891876918

NPI Information

  • NPI: 1891876918
  • Provider Name: MOTHER LODE PHARMACIES, INC.
  • Classification: Pharmacy - 333600000X
  • Entity Type: Organization
  • Doing Business As: KELLY'S DRUG STORE
  • Address: 64 E. SAINT CHARLES ST
    SAN ANDREAS, CA
    ZIP 95249
  • Phone: (209) 754-3595

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NPI Details

MOTHER LODE PHARMACIES, INC. is a pharmacy in San Andreas, CA. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. MOTHER LODE PHARMACIES, INC. NPI is 1891876918. The provider is registered as an organization entity type.
The provider Is Doing Business As Kelly's Drug Store.

The provider's business location address is:

64 E. SAINT CHARLES ST
SAN ANDREAS, CA
ZIP 95249-009
Phone: (209) 754-3595
Fax: (209) 754-5387

The provider's authorized official is Raymond L Guidi .
The authorized official title is President and has the following contact phone number (209) 754-3595.

The enumeration date for this NPI number is 10/17/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacy417030CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1PHA417030MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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