Provider Demographics
NPI:1770598153
Name:COBBLESTONE PHARMACY
Entity type:Organization
Organization Name:COBBLESTONE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:530-877-3712
Mailing Address - Street 1:6585 CLARK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3500
Mailing Address - Country:US
Mailing Address - Phone:530-877-3712
Mailing Address - Fax:530-877-5739
Practice Address - Street 1:6585 CLARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3500
Practice Address - Country:US
Practice Address - Phone:530-877-3712
Practice Address - Fax:530-877-5739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY370923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY37092OtherPHARMACY LICENSE/PERMIT
CA05-30281OtherNCPDP NUMBER
CAPHA370920Medicaid
CA05-30281OtherNCPDP NUMBER