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General NPI Number Information
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NPI Number | 1699838763
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Entity Type | Organization
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Legal Business Name | STUDENT HEALTH CTR PHARMACY
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1801 E COTATI AVE STUDENT HEALTH CENTER
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City | ROHNERT PARK
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State | CA
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Zip | 94928-3613
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Country | US
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Telephone | 707-664-2921
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Fax | 707-664-2925
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Provider Business Mailing Address
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Address Line | 1801 E. COTATI AVE STUDENT HEALTH CENTER
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City | ROHNERT PARK
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State | CA
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Zip | 94928
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Country | US
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Telephone | 707-664-2921
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Fax | 707-664-2925
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. IRVIN WILLIAM WHITAKER
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Credential | R.PH.
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Telephone | 707-664-2921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | PHE19589
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | PHE 19589
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License Number State | CA
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