Healthcare Provider Details

I. General information

NPI: 1790305530
Provider Name (Legal Business Name): COMPUTER CONSUMER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 CASA GRANDE AVE
ROCKLIN CA
95677-2668
US

IV. Provider business mailing address

5865 CASA GRANDE AVE
ROCKLIN CA
95677-2668
US

V. Phone/Fax

Practice location:
  • Phone: 916-676-5491
  • Fax:
Mailing address:
  • Phone: 916-676-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHNATHON KINGSLEY BEST
Title or Position: OWNER
Credential:
Phone: 916-676-5491