MEDICARE: TEHAMA PHARMACY AND TRADING COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	51778	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2145124	OTHER		PK

General Provider Information

NPI Number	:	1073518015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEHAMA PHARMACY AND TRADING COMPANY

Provider Business Mailing Address
First Line	:	401 WALNUT ST
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-3319
Country	:	US
Telephone Number	:	530-527-4636
Fax Number	:	530-527-1344

Provider Business Practice Location Address
First Line	:	401 WALNUT ST
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-3319
Country	:	US
Telephone Number	:	530-527-4636
Fax Number	:	530-527-1344

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BIANCA BRADSHAW
Credential	:
Telephone Number	:	530-527-4636

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/31/2023

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