JAIL HEALTH SERVICES PHARMACY (NPI# 1104033661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104033661 |
| Entity Type | Organization |
| Organization Name | JAIL HEALTH SERVICES PHARMACY |
| Practice Address |
1 Moreland Drive Cj#5 Pharmacy San Bruno CA 94066-1670 |
| Mailing Address |
425 7th Street San Francisco CA 94103 |
| Practice Telephone | 6502661739 |
| Practice Fax Number | 6502661740 |
| Mailing Telephone | 4155754320 |
| Mailing Fax Number | 4155754344 |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2019-06-12 |
| Authorized Official Name | DR. LISA PRATT (DIRECTOR, JAIL HEALTH SERVICES) |
| Authorized Official Telephone | 4159951701 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2400X |
Clinic/Center Specialization: Prison Health |
LCF40885 | CA | Ambulatory Health Care Facilities |
| Y | 261QP2400X |
Clinic/Center Specialization: Prison Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | LICENSED CORRECTIONAL FAC | LCF40885 | 01 |
| Street Address |
1 MORELAND DRIVE CJ#5 PHARMACY |
| City | SAN BRUNO |
| State | CA |
| Zip Code | 94066-1670 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497392468 | Harold Relosimon | Behavior Technician | 901 Sneath Lane, Suite 105, San Bruno, Ca 94066, San Bruno, CA 94066 | 2019-12-09 |
| 1093365926 | Liana Greene | Behavior Technician | 1001 Sneath Lane #200, San Bruno, CA 94066 | 2019-09-12 |
| 1568018406 | Susan Page Gadegone | Community Health Worker | 931 San Bruno West Avenue Suite 2, San Bruno, CA 94066 | 2019-08-15 |
| 1184198780 | Sonya Oey Kramer | Pharmacist | 10 Bayhill Drive, San Bruno, CA 94066 | 2019-01-16 |
| 1316410350 | Brennen Marques Mcdowell | Behavioral Analyst | 101 Sneath Lane Ste. 200, 200, San Bruno, CA 94066 | 2019-01-02 |
| 1306317649 | Jacqueline R Lalucis | Behavior Technician | 751 Camino Plaza, San Bruno, Ca 94066, A, San Bruno, CA 94066 | 2018-12-16 |
| 1992275952 | Kenny Malunay | Behavior Technician | 75a El Camino Plaza, San Bruno, CA 94066 | 2018-12-03 |
| 1396236584 | Mariela Pena Yerena | Behavior Technician | 751 El Camino Plaza, Suite A, San Bruno, CA 94066 | 2018-05-23 |
| 1568845816 | Paula Leeanne Park | Physical Therapist | 106 Quail Point Cir, San Bruno, CA 94066 | 2015-07-06 |
| 1275921231 | C & C's Care Home | Assisted Living Facility | 2700 Oakmont Dr., San Bruno, CA 94066 | 2014-12-29 |
| Find all providers in zip 94066 | ||||
| Taxonomy Code | 261QP2400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Prison Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801435631 | County of Sacramento | Clinic/Center | 651 I Street, Sacramento, CA 95814 | 2019-12-26 |
| 1801430418 | Federal Correctional Complex Lompoc | Clinic/Center | 3901 Klein Blvd, Lompoc, CA 93436-2706 | 2019-11-06 |
| 1861052060 | County of San Mateo | Clinic/Center | 1300 Maple St., Redwood City, CA 94063 | 2019-06-19 |
| 1750941977 | County of San Mateo | Clinic/Center | 300 Bradford St., Redwood City, CA 94063 | 2019-06-19 |
| 1669032868 | County of San Mateo | Clinic/Center | 222 Paul Scannell Dr., San Mateo, CA 94402 | 2019-06-19 |
| 1841620689 | Orange County Health Care Agency | Clinic/Center | 550 N. Flower Street, Santa Ana, CA 92706 | 2013-11-14 |
| 1154621555 | American Correctional Solutions, Inc. | Clinic/Center | 1588 N Batavia St, Orange, CA 92867-3553 | 2010-11-01 |
| 1598847519 | Jail Psych Services - Rccc | Clinic/Center | 12450 Bruceville Rd, Elk Grove, CA 95757-9784 | 2006-10-19 |
| 1780181222 | Department of State Hospital Coalinga | Clinic/Center | 24511 W Jayne Ave, Coalinga, CA 93210-9516 | 2018-04-11 |
| 1467982017 | California Forensic Medical Group, Inc. | Clinic/Center | 5325 Broder Blvd, Dublin, CA 94568-3309 | 2017-06-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.