Healthcare Provider Details

I. General information

NPI: 1114403797
Provider Name (Legal Business Name): INUSA JAFARU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 HIGHWAY 49
SUTTER CREEK CA
95685
US

IV. Provider business mailing address

475 HIGHWAY 49
SUTTER CREEK CA
95685
US

V. Phone/Fax

Practice location:
  • Phone: 209-267-5128
  • Fax: 209-267-9146
Mailing address:
  • Phone: 209-267-5128
  • Fax: 209-267-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: