Healthcare Provider Details

I. General information

NPI: 1457464034
Provider Name (Legal Business Name): WILLOW CREEK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39050 HIGHWAY 299
WILLOW CREEK CA
95573-0067
US

IV. Provider business mailing address

PO BOX 112
WILLOW CREEK CA
95573-0112
US

V. Phone/Fax

Practice location:
  • Phone: 530-629-3144
  • Fax: 530-629-4303
Mailing address:
  • Phone: 530-629-3144
  • Fax: 530-629-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVE JORGENSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 530-629-3144