Healthcare Provider Details

I. General information

NPI: 1093830853
Provider Name (Legal Business Name): COUNTY OF SANTA CRUZ HEALTH SERVICES AGENCY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

IV. Provider business mailing address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-4587
  • Fax: 831-454-4893
Mailing address:
  • Phone: 831-454-4587
  • Fax: 831-454-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHE 6576
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHE 6576
License Number StateCA

VIII. Authorized Official

Name: ANDRE MESCHI
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 831-454-5454