Provider Demographics
NPI:1033394515
Name:BIGGS-GRIDLEY MEM. HOSP. PHARMACY
Entity Type:Organization
Organization Name:BIGGS-GRIDLEY MEM. HOSP. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:DADDOW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:530-846-9074
Mailing Address - Street 1:240 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-2216
Mailing Address - Country:US
Mailing Address - Phone:530-846-9074
Mailing Address - Fax:
Practice Address - Street 1:240 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-2216
Practice Address - Country:US
Practice Address - Phone:530-846-9074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X
CAHSP46719282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
120083OtherNHIN
CAPHB467190Medicaid
CA5614501OtherNCPDP
CAPHB467190Medicaid