MENDOCINO PHARMACY HOLDINGS INC. (NPI# 1205453586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205453586 |
| Entity Type | Organization |
| Organization Name | MENDOCINO PHARMACY HOLDINGS INC. |
| Practice Address |
39251 South Highway 1 Gualala CA 95445 |
| Mailing Address |
Po Box 904 Mendocino CA 95460-0904 |
| Practice Telephone | 7077340091 |
| Practice Fax Number | 7079623011 |
| Mailing Telephone | 7077340091 |
| Mailing Fax Number | 7079623011 |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2020-07-02 |
| Authorized Official Name | KELLY E BRODETSKY (PRESIDENT, DIRECTOR) |
| Authorized Official Telephone | 7077340091 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Gualala Community Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700393865 | Mendocino Pharmacy Holdings Inc. | Pharmacy | 10501 Lansing St., Mendocino, CA 95460-0904 | 2018-01-10 |
| 1619216173 | Mendocino Pharmacy Holdings Inc. | Pharmacy | 350 Cypress St, Fort Bragg, CA 95437-5408 | 2013-02-04 |
| Street Address |
39251 SOUTH HIGHWAY 1 |
| City | GUALALA |
| State | CA |
| Zip Code | 95445 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922659499 | Lucinda Weaver Physical Therapy | Clinic/Center | 39120 Ocean Dr, Gualala, CA 95445 | 2019-09-25 |
| 1275858573 | James Edwin Platt | Chiropractor | 38820 Hwy. 1, Suite 108, Gualala, CA 95445 | 2010-03-30 |
| 1184862013 | Lucinda Weaver I | Physical Therapist | 39120 Ocean Dr., Gualala, CA 95445 | 2009-01-30 |
| 1902050669 | Gena Lynn Davis | Optometrist | 39150 Ocean Drive, Suite 2a, Gualala, CA 95445 | 2008-11-07 |
| 1477731032 | Carolee Brady | Marriage & Family Therapist | 38550 S Hwy 1, Gualala, CA 95445 | 2008-02-06 |
| 1053432971 | Barbara Brittell | Physician Assistant | 46900 Ocean Drive, Redwood Coast Medical Services, Gualala, CA 95445 | 2007-04-02 |
| 1174658298 | Richard T Miner | Chiropractor | 38690 Pacific Dr., Suite 3, Gualala, CA 95445 | 2007-02-22 |
| 1104962638 | Robert Arnold Nelson | Ophthalmology | 30150 So Hwy One, Gualala, CA 95445 | 2007-01-30 |
| 1982808119 | Allen B. Cox Jr. | Dentist | 38460 S. Highway One, Gualala, CA 95445-1199 | 2007-06-12 |
| 1265824767 | Susan Patricia Chapler | General Practice | 44710 Moonrise Dr, Gualala, CA 95445-7503 | 2015-02-20 |
| Find all providers in zip 95445 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699848663 | Gualala Pharmacy, Inc. | Pharmacy | 39351 S Highway 1, Gualala, CA 95445-9571 | 2006-11-16 |
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|---|---|---|---|---|
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| 1225636889 | Med-plus Pharmacy Inc | Pharmacy | 335 Lindbergh Ave, Livermore, CA 94551-9291 | 2020-10-15 |
| 1689271066 | Innova Pharmacy Iv | Pharmacy | 4815 Watt Ave Ste B101, North Highlands, CA 95660-5108 | 2020-10-08 |
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| 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.