Boulder Creek Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY39145 Issued in CA

Legal business name

BOULDER CREEK PHARMACY INC

Practice address

6240 Highway 9
Felton, CA 95018-9713

Phone

(831) 335-4461

NPI assigned

Jan 17, 2007

Organization subpart

No

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

Authorized official

Name

Robert Locatelli, RPH

Title

Owner

Phone

(831) 338-2144

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• FELTON PHARMACY Doing business as

Tax ID family

A Calif Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Boulder Creek Pharmacy

  • Pharmacy
  • Boulder Creek, CA
  • NPI 1629165584
  NPD tax ID

Locations

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228176000000",
    "number": "1689726937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6240 HIGHWAY 9",
            "city": "FELTON",
            "state": "CA",
            "postal_code": "950189713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6240 HIGHWAY 9",
            "city": "FELTON",
            "state": "CA",
            "postal_code": "950189713",
            "telephone_number": "831-335-4461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER CREEK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2008-12-02",
        "status": "A",
        "authorized_official_last_name": "LOCATELLI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "831-338-2144",
        "authorized_official_credential": "RPH"
    },
    "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": "PHY39145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0501280",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA188600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FELTON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aleah Rose Rusoff Armstrong
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• Maria Ellen Ariagno Ballard, MPT
• Natalie Banys
• Samantha Blenderman, DDS
• Natalia Bytheway
• Neta Caspi, N.D.
• Regan Clementi, OTR/L
• Lorna Marina Coetzee, CARETAKER
• Dawn Collins, LMFT

• All providers in Felton, CA
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; 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.