Healthcare Provider Details

I. General information

NPI: 1972524924
Provider Name (Legal Business Name): CALIFORNIA STATE UNIVERSITY, SACRAMENTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 J ST FL 1 THE WELL
SACRAMENTO CA
95819-2605
US

IV. Provider business mailing address

6000 J ST FL 1 THE WELL
SACRAMENTO CA
95819-2605
US

V. Phone/Fax

Practice location:
  • Phone: 916-278-6040
  • Fax: 916-278-6046
Mailing address:
  • Phone: 916-278-6040
  • Fax: 916-278-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHE17371
License Number StateCA

VIII. Authorized Official

Name: JOY STEWART-JAMES
Title or Position: EXECUTIVE DIRECTOR
Credential: PHARMD
Phone: 916-278-6049