MCCLELLAN VA CBOC PHARMACY (2869)    INSTITUTION (4)

Name Value
NAME MCCLELLAN VA CBOC PHARMACY
STATE CALIFORNIA
STREET ADDR. 1 5342 DUDLEY BLVD BLDG 98
CITY MCCLELLAN
ZIP 95652-1012
OFFICIAL VA NAME MCCLELLAN VA CBOC PHARMACY
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME MCCLELLAN VA CBOC PHARMACY
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1588612329
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE PACIFIC
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
HISTORY
  • STREET ADDR. 1 (CHANGED FROM):   5342 DUDLEY BOULEVARD
    STREET ADDR. 2 (CHANGED FROM):   BUILDING 98
    CITY (CHANGED FROM):   MCCLELLAN
    STATE (CHANGED FROM):   CALIFORNIA
    ZIP (CHANGED FROM):   95652-1012
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1588612329