Palo Cedro Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY47063 Issued in CA

Legal business name

PALO CEDRO PHARMACY

Doing business as

PALO CEDRO PHARMACY

Practice address

9180 Deschutes Rd
Palo Cedro, CA 96073-8716

Phone

(530) 547-4465

Fax

(530) 547-4560

NPI assigned

Feb 12, 2007

Organization subpart

No

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

Authorized official

Name

Dean Wofford, PHARM D

Title

Owner

Phone

(530) 547-4465

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PALO CEDRO PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1578604435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9180 DESCHUTES RD",
            "city": "PALO CEDRO",
            "state": "CA",
            "postal_code": "960738716",
            "telephone_number": "530-547-4465",
            "fax_number": "530-547-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9180 DESCHUTES RD",
            "city": "PALO CEDRO",
            "state": "CA",
            "postal_code": "960738716",
            "telephone_number": "530-547-4465",
            "fax_number": "530-547-4560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALO CEDRO PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "WOFFORD",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-547-4465",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY47063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA470630",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0552807",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PALO CEDRO PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Palo Cedro, CA
• Providers in Palo Cedro, 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 Jun 16, 2010; 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.