# PRESTON YOUTH CORRECTIONAL FACILITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033263488
- **Authorized official:** KENNETH ERLEBUSCH RPH (PHRM)
- **Authorized official phone:** (209) 274-8275

## Contact information

- **Practice address:** 201 WATERMAN RD, IONE, CA 95640-9701
- **Practice address phone:** (209) 274-8275
- **Practice address fax:** (209) 274-0865
- **Mailing address:** 201 WATERMAN RD, IONE, CA 95640-9701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | LCF44606 | CA | Yes |

## Other

- **Enumeration date:** 01/23/2007
- **Last updated:** 09/12/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5625174 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |