=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194170092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NSH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2016
-----------------------------------------------------
Last Update Date | 04/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 NAPA VALLEJO HWY
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-6234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-253-5264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3079 ORCHARD VIEW CT
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94534-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | JATINDER GILL
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 916-996-4924
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | 68087
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------