=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427119510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN JOAQUIN GENERAL HOSPITAL PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 06/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W HOSPITAL RD
-----------------------------------------------------
City | FRENCH CAMP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-468-6028
-----------------------------------------------------
Fax | 209-468-6035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W HOSPITAL RD
-----------------------------------------------------
City | FRENCH CAMP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-468-6028
-----------------------------------------------------
Fax | 209-468-6035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOSPITAL PHARMACY MANAGER
-----------------------------------------------------
Name | JENNIFER HIRAI
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 209-468-6027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | HPE2947
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------