Provider Demographics
NPI:1679353619
Name:REDWOOD COMMUNITY PHARMACY
Entity type:Organization
Organization Name:REDWOOD COMMUNITY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:OTTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-633-4884
Mailing Address - Street 1:1567 CITY CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3600
Mailing Address - Country:US
Mailing Address - Phone:707-633-4884
Mailing Address - Fax:
Practice Address - Street 1:1567 CITY CENTER RD
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3600
Practice Address - Country:US
Practice Address - Phone:707-633-4884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-05
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty