1295893121 NPI number — SUTTER HEALTH SACRAMENTO SIERRA REGION

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 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".




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