MEDICARE: COW CREEK ENTERPRISES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY47167	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0589448	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881605418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COW CREEK ENTERPRISES INC

Provider Business Mailing Address
First Line	:	9390 DESCHUTES RD
Second Line	:
City	:	PALO CEDRO
State	:	CA
Zip	:	96073-9763
Country	:	US
Telephone Number	:	530-547-4403
Fax Number	:	530-547-4845

Provider Business Practice Location Address
First Line	:	9390 DESCHUTES RD
Second Line	:
City	:	PALO CEDRO
State	:	CA
Zip	:	96073-9763
Country	:	US
Telephone Number	:	530-547-4403
Fax Number	:	530-547-4845

Authorized Official
Title or Position	:	VP/MGR TECHNICIAN
Name	:	MARILYN HARNDEN
Credential	:
Telephone Number	:	530-547-4403

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/13/2012

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Directions to “COW CREEK ENTERPRISES INC ” Practice Location

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