Provider Demographics
NPI:1841546132
Name:COUNTY OF PLACER
Entity type:Organization
Organization Name:COUNTY OF PLACER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLIENT SERVICES PROGRAM MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-886-2910
Mailing Address - Street 1:11583 C AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2703
Mailing Address - Country:US
Mailing Address - Phone:530-886-3422
Mailing Address - Fax:
Practice Address - Street 1:11583 C AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2703
Practice Address - Country:US
Practice Address - Phone:530-886-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE307053336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5644427OtherNCPDP PROVIDER IDENTIFICATION NUMBER