Provider Demographics
NPI:1104033661
Name:JAIL HEALTH SERVICES PHARMACY
Entity Type:Organization
Organization Name:JAIL HEALTH SERVICES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, JAIL HEALTH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-995-1701
Mailing Address - Street 1:425 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103
Mailing Address - Country:US
Mailing Address - Phone:415-575-4320
Mailing Address - Fax:415-575-4344
Practice Address - Street 1:1 MORELAND DRIVE CJ#5 PHARMACY
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1670
Practice Address - Country:US
Practice Address - Phone:650-266-1739
Practice Address - Fax:650-266-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCF40885261QP2400X
261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCF40885OtherLICENSED CORRECTIONAL FAC