Healthcare Provider Details

I. General information

NPI: 1790442952
Provider Name (Legal Business Name): TEHAMA PHARMACY AND TRADING COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WALNUT ST
RED BLUFF CA
96080-3319
US

IV. Provider business mailing address

401 WALNUT ST
RED BLUFF CA
96080-3319
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-4636
  • Fax: 530-527-1344
Mailing address:
  • Phone: 530-527-4636
  • Fax: 530-527-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BIANCA BRADSHAW
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: PHARMD
Phone: 530-527-4636