Pokerville Drug

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY39679 Issued in CA

Legal business name

POKERVILLE DRUG

Practice address

18170 Hwy 49
Suite a
Plymouth, CA 95669

Phone

(209) 245-3784

Fax

(209) 245-4146

NPI assigned

Aug 10, 2006

Last updated

Feb 19, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul Wesseler

Title

Owner

Phone

(209) 245-3784

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1013928605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18170 HWY 49",
            "address_2": "SUITE A",
            "city": "PLYMOUTH",
            "state": "CA",
            "postal_code": "95669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18170 HWY 49",
            "address_2": "SUITE A",
            "city": "PLYMOUTH",
            "state": "CA",
            "postal_code": "95669",
            "telephone_number": "209-245-3784",
            "fax_number": "209-245-4146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POKERVILLE DRUG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "WESSELER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-245-3784"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY39679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA396790",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "0553013",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0553013",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheri Lynn Lawrence
• Arely Yanira Macias
• Connie McKenna, L.AC.
• Aleila Monge, PPS
• Robert Michael Negrete, PT, DPT
• Christina Lobue Sonnenberg, RDN, IFNCP
• Patricia Sullivan, NP
• Sutter Health Sacramento Sierra Region (Sutter Amador Health Center - Plymouth)
• Sutter Valley Medical Foundation (Sutter Medical Foundation Plymouth Health Center)
• Lucy Anne Valencia, D.D.S.

• Community/Retail Pharmacy in Plymouth, CA
• Providers in Plymouth, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.