Provider Demographics
NPI:1275039299
Name:WHEATLAND APOTHECARY LLC
Entity Type:Organization
Organization Name:WHEATLAND APOTHECARY LLC
Other - Org Name:OROVILLE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:MURALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-591-5604
Mailing Address - Street 1:2780 OLIVE HWY
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6104
Mailing Address - Country:US
Mailing Address - Phone:530-730-5265
Mailing Address - Fax:530-730-5254
Practice Address - Street 1:2780 OLIVE HWY
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6104
Practice Address - Country:US
Practice Address - Phone:530-730-5265
Practice Address - Fax:530-730-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY555913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176995OtherPK