Shana K Acosta, PHARM.D

Individual provider Active NPI Pharmacist · Grass Valley, CA

NPI 1376017996 · NPPES record last updated Jan 16, 2019

Key facts

NPI
1376017996
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
79658 (CA)
Practice address
1005 Sutton Way
Grass Valley, CA 95945-5182
Phone
(530) 272-8881
NPI assigned
Jan 16, 2019
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
79658CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Longs Drug Stores California LLC Past Accepting new patients
Longs Drug Store California LLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 79658 CA Yes

Addresses

Primary practice location

1005 Sutton Way
Grass Valley, CA 95945-5182

Mailing address

1005 Sutton Way
Grass Valley, CA 95945-5182

Other providers in Grass Valley, CA

All providers in Grass Valley, CA · Pharmacist in California

Sources for this page

Verify at the official NPI Registry.