Healthcare Provider Details

I. General information

NPI: 1952342859
Provider Name (Legal Business Name): MICHAEL A CELAYETA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64012 HILLSIDE RD
HAPPY CAMP CA
96039
US

IV. Provider business mailing address

PO BOX 425
HAPPY CAMP CA
96039-0425
US

V. Phone/Fax

Practice location:
  • Phone: 530-493-2070
  • Fax: 530-493-2068
Mailing address:
  • Phone: 530-493-2070
  • Fax: 530-493-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY39288
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CELAYETA
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 530-493-2070