Provider Demographics
NPI:1841739703
Name:LAST FRONTIER HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:LAST FRONTIER HEALTHCARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:KENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:530-708-8850
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-0190
Mailing Address - Country:US
Mailing Address - Phone:530-708-8850
Mailing Address - Fax:530-233-4449
Practice Address - Street 1:1111 N NAGLE ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3840
Practice Address - Country:US
Practice Address - Phone:530-708-8850
Practice Address - Fax:530-233-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CAPHE545403336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7623541Medicaid
2167729OtherPK