Organization
NUGGET MARKET PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY NOOTEBOOM RPH (PHARMACIST IN CHARGE)
(530) 662-0961
Entity
Organization
Contact information
Practice address
157 MAIN ST, WOODLAND, CA 95695-3125
(530) 662-0961
(530) 668-5597
Mailing address
157 MAIN ST, WOODLAND, CA 95695-3125
(530) 662-0961
(530) 668-5597
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
PHY 40465
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA404650
—
CA
Enumeration date
11/09/2006
Last updated
08/22/2020
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