Healthcare Provider Details

I. General information

NPI: 1871898304
Provider Name (Legal Business Name): CORRECTIONS AND REHABILITATION-HEADQUARTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 O'BYRNES FERRY ROAD ATTN: PHARMACY
JAMESTOWN CA
95327
US

IV. Provider business mailing address

5100 O'BYRNES FERRY ROAD ATTN: PHARMACY
JAMESTOWN CA
95327
US

V. Phone/Fax

Practice location:
  • Phone: 209-984-5291
  • Fax: 209-984-0630
Mailing address:
  • Phone: 209-984-5291
  • Fax: 209-984-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberLCF 40998
License Number StateCA

VIII. Authorized Official

Name: PIERRE CAESARE SAUCIER JAMES
Title or Position: STAFF SERVICES MANAGER I
Credential:
Phone: 510-780-6997