Provider Demographics
NPI:1881605418
Name:COW CREEK ENTERPRISES INC
Entity type:Organization
Organization Name:COW CREEK ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/MGR TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-547-4403
Mailing Address - Street 1:9390 DESCHUTES RD
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-9763
Mailing Address - Country:US
Mailing Address - Phone:530-547-4403
Mailing Address - Fax:530-547-4845
Practice Address - Street 1:9390 DESCHUTES RD
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-9763
Practice Address - Country:US
Practice Address - Phone:530-547-4403
Practice Address - Fax:530-547-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY471673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0589448OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA471670Medicaid