Organization
MENDOCINO PHARMACY HOLDINGS INC.
Active
Other names
Mendocino Coast Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY E BRODETSKY PHARMD (DIRECTOR/PHARMACIST IN CHARGE)
(707) 734-0091
Entity
Organization
Contact information
Practice address
350 CYPRESS ST, FORT BRAGG, CA 95437-5408
(707) 962-0800
(707) 962-3011
Mailing address
PO BOX 904, MENDOCINO, CA 95460-0904
(707) 962-0800
(707) 962-3011
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5646469
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/04/2013
Last updated
07/23/2020
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