Organization
STUDENT HEALTH CTR PHARMACY
Active
Other names
Sonoma State University
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IRVIN WILLIAM WHITAKER R.PH. (PHARMACIST IN CHARGE)
(707) 664-2921
Entity
Organization
Contact information
Practice address
1801 E COTATI AVE, STUDENT HEALTH CENTER, ROHNERT PARK, CA 94928-3613
(707) 664-2921
(707) 664-2925
Mailing address
1801 E. COTATI AVE, STUDENT HEALTH CENTER, ROHNERT PARK, CA 94928
(707) 664-2921
(707) 664-2925
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
PHE19589
CA
261QS1000X
Student Health Clinic/Center
Primary
PHE 19589
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHE 19589
RETAIL PHARMACY LICENSE
CA
Enumeration date
12/19/2006
Last updated
03/07/2023
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