1295893121 NPI number — SUTTER HEALTH SACRAMENTO SIERRA REGION

Table of content: (NPI 1295893121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295893121 NPI number — SUTTER HEALTH SACRAMENTO SIERRA REGION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTER HEALTH SACRAMENTO SIERRA REGION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUTTER MIDTOWN PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295893121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 L ST
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95816-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-454-6744
Provider Business Mailing Address Fax Number:
916-454-6745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 L ST
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-454-6744
Provider Business Practice Location Address Fax Number:
916-454-6745
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RED
Authorized Official First Name:
CARL
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
916-454-6744

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PHY42089 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0546993 . This is a "NCPDP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHY42089 . This is a "PHARMACY LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHA420890 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com