Provider Demographics
NPI:1093830853
Name:COUNTY OF SANTA CRUZ HEALTH SERVICES AGENCY PHARMACY
Entity Type:Organization
Organization Name:COUNTY OF SANTA CRUZ HEALTH SERVICES AGENCY PHARMACY
Other - Org Name:COUNTY OF SANTA CRUZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:831-454-5454
Mailing Address - Street 1:1080 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1966
Mailing Address - Country:US
Mailing Address - Phone:831-454-4587
Mailing Address - Fax:831-454-4893
Practice Address - Street 1:1080 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1966
Practice Address - Country:US
Practice Address - Phone:831-454-4587
Practice Address - Fax:831-454-4893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SANTA CRUZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE 6576333600000X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHE6576OtherBOARD OF PHARMACY
CAPHOB65760Medicaid