Provider Demographics
NPI:1780687277
Name:JCH PHARMACY HOLDINGS INC
Entity Type:Organization
Organization Name:JCH PHARMACY HOLDINGS INC
Other - Org Name:PUCCI'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:916-442-5891
Mailing Address - Street 1:3257 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5220
Mailing Address - Country:US
Mailing Address - Phone:916-442-5891
Mailing Address - Fax:916-442-4432
Practice Address - Street 1:3257 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5220
Practice Address - Country:US
Practice Address - Phone:916-442-5891
Practice Address - Fax:916-442-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54556333600000X
333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160754OtherPK
CA1780687277Medicaid
2160754OtherPK