Provider Demographics
NPI:1386843167
Name:VETERANS HOME OF CALIFORNIA
Entity Type:Organization
Organization Name:VETERANS HOME OF CALIFORNIA
Other - Org Name:VETERANS HOME OF CALIFORNIA PHARMACY SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KATE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:707-944-4616
Mailing Address - Street 1:123 CALIFORNIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:YOUNTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94599
Mailing Address - Country:US
Mailing Address - Phone:707-944-4616
Mailing Address - Fax:707-944-4629
Practice Address - Street 1:123 CALIFORNIA DRIVE
Practice Address - Street 2:
Practice Address - City:YOUNTVILLE
Practice Address - State:CA
Practice Address - Zip Code:94599
Practice Address - Country:US
Practice Address - Phone:707-944-4616
Practice Address - Fax:707-944-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE 195633336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHE-19563OtherSTATE LICENSE NO.