Provider Demographics
NPI:1609038751
Name:KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:KAWEAH DELTA HEALTH CARE DISTRICT
Other - Org Name:KAWEAH HEALTH SOUTH CAMPUS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:SRVP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-624-4065
Mailing Address - Street 1:400 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1633 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4945
Practice Address - Country:US
Practice Address - Phone:559-624-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHPE465963336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHB342090Medicaid