NPIMap

Organization Active NPI

Corrections and Rehabilitation-Headquarters

Doing business as Pelican Bay State Prison Pharmacy

  • Pharmacy
  • Crescent City, CA
National Provider Identifier
1053946889
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
CORRECTIONS AND REHABILITATION-HEADQUARTERS
Doing business as
Pelican Bay State Prison Pharmacy
Practice address
5905 Lake Earl Dr
Crescent City, CA 95532-0001
Phone
(707) 465-1000
Fax
(707) 465-9178
NPI assigned
Mar 12, 2020
Last updated
Dec 4, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CORRECTIONS AND REHABILITATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Authorized official

Name
Pierre Caesare Saucier James
Title
Staff Services Manager I
Phone
(510) 780-6997

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU Primary

Addresses

Primary practice location

5905 Lake Earl Dr
Crescent City, CA 95532-0001

Mailing address

5905 Lake Earl Dr
Crescent City, CA 95532-0001
Phone (707) 465-1000

Other names 1

  • Pelican Bay State Prison Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Corrections and Rehabilitation-Headquarters42 organizations share this tax ID, including this one
Part of
Corrections and Rehabilitation-Headquarters

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Locations

5905 Lake Earl Dr
Crescent City, CA 95532

NPI Registry JSON

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

{
    "created_epoch": "1583971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1053946889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5905 LAKE EARL DR",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955320001",
            "telephone_number": "707-465-1000",
            "fax_number": "707-465-9178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5905 LAKE EARL DR",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955320001",
            "telephone_number": "707-465-1000",
            "fax_number": "707-465-9178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORRECTIONS AND REHABILITATION-HEADQUARTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORRECTIONS AND REHABILITATION",
        "enumeration_date": "2020-03-12",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "PIERRE",
        "authorized_official_middle_name": "CAESARE SAUCIER",
        "authorized_official_title_or_position": "STAFF SERVICES MANAGER I",
        "authorized_official_telephone_number": "510-780-6997"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pelican Bay State Prison Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pelican Bay State Prison Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crescent City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.