Provider Demographics
NPI:1275172975
Name:COMMUNITY HEALTH CENTERS OF AMERICA
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF AMERICA
Other - Org Name:COMMUNITY HEALTH CENTERS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRATAP
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-298-1715
Mailing Address - Street 1:517 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-1427
Mailing Address - Country:US
Mailing Address - Phone:209-298-1715
Mailing Address - Fax:
Practice Address - Street 1:517 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-1427
Practice Address - Country:US
Practice Address - Phone:209-340-7929
Practice Address - Fax:209-348-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57564OtherPHARMACY LICENSE
CA57564OtherPHARMACY LICENSE