Organization
SEBASTOPOL FAMILY PHARMACY, INC.
Active
Other names
Sebastopol Family Pharmacy, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
AMALIA NICOLA (PRESIDENT/OWNER)
(707) 869-9055
Entity
Organization
Contact information
Practice address
652 PETALUMA AVE STE I1, SEBASTOPOL, CA 95472-4266
(707) 869-9055
(707) 869-9861
Mailing address
16251 MAIN ST, GUERNEVILLE, CA 95446-8300
(707) 869-9055
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY55959
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176893
PK
—
Enumeration date
04/06/2018
Last updated
04/06/2018
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