NPIMap

Organization Active NPI

M a C T Health Board, Incorporated

Doing business as MACT Pharmacy

  • Community/Retail Pharmacy
  • Sonora, CA
National Provider Identifier
1417527532
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
M A C T HEALTH BOARD, INCORPORATED
Doing business as
MACT Pharmacy
Practice address
13975 Mono Way Ste H
Sonora, CA 95370-2824
Phone
(209) 677-5424
Fax
(888) 498-0976
NPI assigned
Jun 30, 2021
Last updated
Nov 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Authorized official

Name
John Shawver Alexander
Title
Executive Director
Phone
(209) 754-6258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

13975 Mono Way Ste H
Sonora, CA 95370-2824

Mailing address

PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6245

Other identifiers 1

IdentifierTypeStateIssuer
1417527532MedicaidCA

Other names 1

  • MACT Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mact Health Board Incorporated13 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": "1625011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1417527532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939",
            "telephone_number": "209-754-6245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13975 MONO WAY STE H",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953702824",
            "telephone_number": "209-677-5424",
            "fax_number": "888-498-0976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M A C T HEALTH BOARD, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-30",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "SHAWVER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-754-6258"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417527532",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MACT Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MACT Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sonora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; 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.