Organization
PRESTON YOUTH CORRECTIONAL FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH ERLEBUSCH RPH (PHRM)
(209) 274-8275
Entity
Organization
Contact information
Practice address
201 WATERMAN RD, IONE, CA 95640-9701
(209) 274-8275
(209) 274-0865
Mailing address
201 WATERMAN RD, IONE, CA 95640-9701
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
LCF44606
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5625174
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
01/23/2007
Last updated
09/12/2007
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