Provider Demographics
NPI:1114382132
Name:CHCCC COMMUNITY HEALTH CENTER PHARMACY OF THE CENTRAL COAST
Entity Type:Organization
Organization Name:CHCCC COMMUNITY HEALTH CENTER PHARMACY OF THE CENTRAL COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:NISHINAKA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:805-269-1325
Mailing Address - Street 1:150 TEJAS PL
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9123
Mailing Address - Country:US
Mailing Address - Phone:805-270-1800
Mailing Address - Fax:805-270-1820
Practice Address - Street 1:150 TEJAS PL
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9123
Practice Address - Country:US
Practice Address - Phone:805-270-1800
Practice Address - Fax:805-270-1820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHCCC COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-17
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY525913336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy