Provider Demographics
NPI:1619049491
Name:JOHN MUIR HEALTH
Entity Type:Organization
Organization Name:JOHN MUIR HEALTH
Other - Org Name:DIABLO PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-212-0216
Mailing Address - Street 1:2700 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 GRANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2266
Practice Address - Country:US
Practice Address - Phone:925-674-2637
Practice Address - Fax:925-674-2635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN MUIR HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY42917333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0589638OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA341050Medicaid