Organization
SUTTER CENTRAL VALLEY HOSPITALS
Active
Other names
MEMORIAL MEDICAL CENTER OUTPATIENT PHARM
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES BRESHEARS PHARMD (DIRECTOR OF PHARMACY)
(209) 569-7352
Entity
Organization
Contact information
Practice address
1800 COFFEE RD, SUITE 110, MODESTO, CA 95355-2705
(209) 572-7132
(209) 572-7077
Mailing address
1800 COFFEE RD, SUITE 110, MODESTO, CA 95355-2705
(209) 572-7132
(209) 572-7077
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
HSP37596
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0538009
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHB375960
—
CA
Enumeration date
06/24/2006
Last updated
10/06/2010
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