Provider Demographics
NPI:1609865864
Name:COMMUNITY HEATLH CENTERS OF THE CENTRAL COAST
Entity Type:Organization
Organization Name:COMMUNITY HEATLH CENTERS OF THE CENTRAL COAST
Other - Org Name:CHC PHARMACY ATASCADERO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:J CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MITSUOKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:805-269-1326
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:805-269-1326
Mailing Address - Fax:805-269-1388
Practice Address - Street 1:5575 CAPISTRANO AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4264
Practice Address - Country:US
Practice Address - Phone:805-792-1422
Practice Address - Fax:805-792-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 46797261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA467970Medicaid
CAPHY46797OtherPHARMACY LICENSE #
CA5613612OtherNCPDP NUMBER
CABC 8961383OtherDEA NUMBER
CAPHY46797OtherPHARMACY LICENSE #