Healthcare Provider Details

I. General information

NPI: 1265202725
Provider Name (Legal Business Name): JOHN MUIR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 LA CASA VIA STE 270
WALNUT CREEK CA
94598-6101
US

IV. Provider business mailing address

JOHN MUIR HEALTH 177 LA CASA VIA STE 270
WALNUT CREEK CA
94598-6101
US

V. Phone/Fax

Practice location:
  • Phone: 925-947-4410
  • Fax:
Mailing address:
  • Phone: 925-947-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MIKE THOMAS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 925-941-2100