Provider Demographics
NPI:1528136769
Name:NUGGET MARKET PHARMACY
Entity type:Organization
Organization Name:NUGGET MARKET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHRM MNG
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-375-8900
Mailing Address - Street 1:2000 TOWN CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 TOWN CENTER PLZ
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4957
Practice Address - Country:US
Practice Address - Phone:916-375-8900
Practice Address - Fax:916-375-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46887333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5614222OtherOTHER ID NUMBER-COMMERCIAL NUMBER