Organization
SHINGLE SPRINGS RANCHERIA
Active
Other names
Shingle Springs Health and Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BODTKER PHARMD (DIRECTOR OF PHARMACY/PIC/AO)
(530) 387-8005
Entity
Organization
Contact information
Practice address
5168 HONPIE RD, 5TH FLOOR, PLACERVILLE, CA 95667-8682
(530) 387-8215
(530) 676-4416
Mailing address
5168 HONPIE RD, 5TH FLOOR, PLACERVILLE, CA 95667-8682
(530) 387-8005
(530) 387-8006
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
PHY55274
CA
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710423793
—
CA
01
—
2167303
PK
—
Enumeration date
01/13/2017
Last updated
09/19/2025
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