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Organization
SHINGLE SPRINGS RANCHERIA
Active
Organization
SHINGLE SPRINGS RANCHERIA
Active
Other names
Shingle Springs Health and Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BODTKER PHARMD (DIRECTOR OF PHARMACY/PIC/AO)
(530) 387-8005
Entity
Organization
Contact information
Practice address
5168 HONPIE RD, 5TH FLOOR, PLACERVILLE, CA 95667-8682
(530) 387-8215
(530) 676-4416
Mailing address
5168 HONPIE RD, 5TH FLOOR, PLACERVILLE, CA 95667-8682
(530) 387-8005
(530) 387-8006
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
PHY55274
CA
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710423793
—
CA
01
—
2167303
PK
—
Enumeration date
01/13/2017
Last updated
09/19/2025
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