Healthcare Provider Details

I. General information

NPI: 1407992019
Provider Name (Legal Business Name): COUNTY OF SAN JOAQUIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 MICHAEL CANLIS WAY
FRENCH CAMP CA
95231-9781
US

IV. Provider business mailing address

7000 MICHAEL CANLIS WAY
FRENCH CAMP CA
95231-9781
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-4761
  • Fax: 209-468-4772
Mailing address:
  • Phone: 209-468-4761
  • Fax: 209-468-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberLCF37855
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAVIER GUERRERO
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 209-468-4761