1497948442 NPI number — SAN FRANCISCO VAMC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497948442 NPI number — SAN FRANCISCO VAMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN FRANCISCO VAMC
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:
SANTA ROSA VA CLINIC PHARMACY
Provider Other Organization Name Type Code:
5
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:
1497948442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94417
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44101-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-341-3020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2285 CHALLENGER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95407-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-750-6937
Provider Business Practice Location Address Fax Number:
415-750-2055
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POTTER
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
NPI TEAM MEMBER
Authorized Official Telephone Number:
202-382-2579

Provider Taxonomy Codes

  • Taxonomy code: 332100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0588698 . This is a "NCPDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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