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Kelseyville Pharmacy

Debarred entity

Kelseyville Pharmacy is an entity of interest. It has not been found on international sanctions lists.

Type	Company				[sources]
Name	Kelseyville Pharmacy				[sources]
Incorporation date	not available				[sources]
Jurisdiction	not available				[sources]
Country	United States				[sources]
Description	License number(s): PHY 46140 · Provider number(s): PHA170380, CGP140495, 1306156096				[sources]
Registration number	not available				[sources]
Sector	Pharmacy/Pharmacist				[sources]
Address	3720 Main Street, Kelseyville, CA, 95451				[sources]
Last change	2024-11-07	Last processed	2024-11-07	First seen	2024-11-07

Sanctions
Authority	Program	Start date	End date
Department of Health Care Services	-	2019-11-14	-

Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.

United States · DHCS

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