Provider Demographics
NPI:1972925782
Name:CELAYETA, MICHAEL SR (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CELAYETA
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:HAPPY CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:96039-0425
Mailing Address - Country:US
Mailing Address - Phone:530-493-2070
Mailing Address - Fax:530-493-2068
Practice Address - Street 1:64012 HILLSIDE RD.
Practice Address - Street 2:
Practice Address - City:HAPPY CAMP
Practice Address - State:CA
Practice Address - Zip Code:96039-0425
Practice Address - Country:US
Practice Address - Phone:530-493-2070
Practice Address - Fax:530-493-2068
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist