Provider Demographics
NPI:1659477529
Name:REDWOOD PHARMACIES
Entity Type:Organization
Organization Name:REDWOOD PHARMACIES
Other - Org Name:MYRTLETOWNE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:707-442-5774
Mailing Address - Street 1:PO BOX 6400
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6400
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:2006-09-16
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY452203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA452200Medicaid
CAPHA452200Medicaid