Redwood Compounding Pharmacy Inc

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PHY50691 Issued in CA

Legal business name

REDWOOD COMPOUNDING PHARMACY INC

Practice address

600 Martin Ave
Ste 125
Rohnert Park, CA 94928-7919

Phone

(707) 541-6186

Fax

(707) 541-6287

NPI assigned

Nov 22, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Moussie Hailemariam, PHARM D

Title

President/ Pic

Phone

(707) 541-6186

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• REDWOOD COMPOUNDING PHARMACY Doing business as

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

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1598032278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 MARTIN AVE",
            "address_2": "STE 125",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949287919",
            "telephone_number": "707-541-6186",
            "fax_number": "707-541-6287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MARTIN AVE",
            "address_2": "STE 125",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949287919",
            "telephone_number": "707-541-6186",
            "fax_number": "707-541-6287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD COMPOUNDING PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-22",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "HAILEMARIAM",
        "authorized_official_first_name": "MOUSSIE",
        "authorized_official_title_or_position": "PRESIDENT/ PIC",
        "authorized_official_telephone_number": "707-541-6186",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY50691",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY50691",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CA",
            "license": "PHY50691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE BOARD OF PHARMACY RETAIL PERMIT",
            "identifier": "PHY50691",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REDWOOD COMPOUNDING PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Candace M. Ray, FNP
• Claire Ready, MA, PPS
• Rebecca Rebagliati
• Raymund Rebong, DDS, MSD
• Jan Marie Reddick, F.N.P.
• Redwood Empire Medical Supply Inc.
• Sylvia Marie Reed, RN
• Nicholas Steven Regennitter, MD
• Rebecca Renelus, DDS
• Cynthia Sue Renfrew, RN,MS,FNP

• Compounding Pharmacy in Rohnert Park, CA
• Providers in Rohnert Park, CA by specialty
• Compounding Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; 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.