Provider Demographics
NPI:1629075916
Name:REDWOOD PHARMACIES
Entity Type:Organization
Organization Name:REDWOOD PHARMACIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-443-4885
Mailing Address - Street 1:1694 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1403
Mailing Address - Country:US
Mailing Address - Phone:707-443-4885
Mailing Address - Fax:707-443-6527
Practice Address - Street 1:1694 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1403
Practice Address - Country:US
Practice Address - Phone:707-443-4885
Practice Address - Fax:707-443-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY45220333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA452200Medicaid
CAPHY45220OtherSTATE BOARD LICENSE
CAPHA452200Medicaid