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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | Kelseyville Pharmacy | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1306156096 | [sources] | |||
| Registration number | CGP140495 · PHA170380 · PHY 46140 | [sources] | |||
| Sector | Pharmacy/Pharmacist | [sources] | |||
| Address | 3720 Main Street, Kelseyville, CA, 95451 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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