Organization
RUTH A STEWART
Active
Other names
KELSEYVILLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH STEWART PHARMD (OWNER)
(707) 279-1561
Entity
Organization
Contact information
Practice address
3720 MAIN ST, KELSEYVILLE, CA 95451-7420
(707) 279-1561
(707) 279-1000
Mailing address
PO BOX 727, KELSEYVILLE, CA 95451-0727
(707) 279-1561
(707) 279-1000
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY46140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1996034
PK
—
05
—
PHA461400
—
CA
Enumeration date
07/24/2006
Last updated
04/19/2017
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