Provider Demographics
NPI:1386603074
Name:SONORA COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:SONORA COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-536-3698
Mailing Address - Street 1:1000 GREENLEY RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5200
Mailing Address - Country:US
Mailing Address - Phone:209-536-3690
Mailing Address - Fax:209-536-3510
Practice Address - Street 1:1000 GREENLEY RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5200
Practice Address - Country:US
Practice Address - Phone:209-536-3690
Practice Address - Fax:209-536-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
CAHSP402393336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386603074Medicaid
CA1386603074Medicaid