Healthcare Provider Details

I. General information

NPI: 1942435946
Provider Name (Legal Business Name): CHAPA-DE INDIAN HEALTH PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E MAIN ST PHARMACY DEPT
GRASS VALLEY CA
95945-5208
US

IV. Provider business mailing address

1350 E MAIN ST PHARMACY DEPT
GRASS VALLEY CA
95945-5208
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-5968
  • Fax: 530-477-8738
Mailing address:
  • Phone: 530-477-5968
  • Fax: 530-477-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License NumberPHY49917
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: LISA DAVIES
Title or Position: CFO
Credential:
Phone: 530-887-2800