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Organization
STUDENT HEALTH CTR PHARMACY
Active
Organization
STUDENT HEALTH CTR PHARMACY
Active
Other names
Sonoma State University
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IRVIN WILLIAM WHITAKER R.PH. (PHARMACIST IN CHARGE)
(707) 664-2921
Entity
Organization
Contact information
Practice address
1801 E COTATI AVE, STUDENT HEALTH CENTER, ROHNERT PARK, CA 94928-3613
(707) 664-2921
(707) 664-2925
Mailing address
1801 E. COTATI AVE, STUDENT HEALTH CENTER, ROHNERT PARK, CA 94928
(707) 664-2921
(707) 664-2925
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
PHE19589
CA
261QS1000X
Student Health Clinic/Center
Primary
PHE 19589
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHE 19589
RETAIL PHARMACY LICENSE
CA
Enumeration date
12/19/2006
Last updated
03/07/2023
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