Healthcare Provider Details

I. General information

NPI: 1982523999
Provider Name (Legal Business Name): MENDOCINO COAST PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CYPRESS ST
FORT BRAGG CA
95437-5408
US

IV. Provider business mailing address

205 SOUTH ST
FORT BRAGG CA
95437-5540
US

V. Phone/Fax

Practice location:
  • Phone: 707-964-1251
  • Fax: 707-961-2722
Mailing address:
  • Phone: 707-964-1251
  • Fax: 707-961-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LUCRESHA M RENTERIA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-964-1251