NPIMap

Organization Active NPI

Government of Guam Department of Administration

Doing business as Southern Region Community Health Center Pharmacy (SRCHC)

  • Clinic Pharmacy
  • Inarajan, GU
National Provider Identifier
1184796690
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
PCY011 Issued in GU
Legal business name
GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Doing business as
Southern Region Community Health Center Pharmacy (SRCHC)
Practice address
162 As Abman Dr
Inarajan, GU 96917
Phone
(671) 828-7547
Fax
(671) 828-7504
NPI assigned
Nov 14, 2006
Last updated
Sep 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2016

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

Authorized official

Name
Michelle Deloso, RPH
Title
Pharmacy Manager
Phone
(671) 635-7447

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X PCY011 GU Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

162 As Abman Dr
Inarajan, GU 96917

Mailing address

123 Chalan Kareta
Mangilao, GU 96913-6304

Other identifiers 2

IdentifierTypeStateIssuer
2112062OtherPK
636MedicaidGU

Other names 1

  • Southern Region Community Health Center Pharmacy (SRCHC) Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
65D0670482Southern Region Community HLTH Ctr Lab162 As Ap'Man Drive, Inarajan, GU 96917Certificate of waiverSep 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Government of Guam13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1184796690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 CHALAN KARETA",
            "city": "MANGILAO",
            "state": "GU",
            "postal_code": "969136304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 AS ABMAN DR",
            "city": "INARAJAN",
            "state": "GU",
            "postal_code": "96917",
            "telephone_number": "671-828-7547",
            "fax_number": "671-828-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "DELOSO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "671-635-7447",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "GU",
            "license": "PCY011",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2112062",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "636",
            "state": "GU"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Region Community Health Center Pharmacy (SRCHC)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inarajan, GU

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.