Provider Demographics
NPI:1609836634
Name:SONORA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SONORA COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-536-3697
Mailing Address - Street 1:900 GREENLEY RD STE 912
Mailing Address - Street 2:STE 912
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5287
Mailing Address - Country:US
Mailing Address - Phone:209-536-3700
Mailing Address - Fax:209-536-3511
Practice Address - Street 1:900 GREENLEY RD STE 912
Practice Address - Street 2:STE 912
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5287
Practice Address - Country:US
Practice Address - Phone:209-536-3700
Practice Address - Fax:209-536-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY442653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609836634Medicaid
1996135OtherPK
CA1609836634Medicaid