JEFFREY LAIST GORE (NPI# 1891272142) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891272142 |
| Entity Type | Individual |
| Full Name | JEFFREY LAIST GORE |
| Credential | PHARMD |
| Practice Address |
845 S Main St Willits CA 95490-3998 |
| Mailing Address |
Po Box 1804 Willits CA 95490-1804 |
| Practice Telephone | 7074561790 |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2018-07-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 77724 | CA | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144521055 | Jeffrey Michael Gore | Social Worker | 189 Glenway St, Dorchester, MA 02121-4111 | 2010-11-09 |
| Street Address |
845 S MAIN ST |
| City | WILLITS |
| State | CA |
| Zip Code | 95490-3998 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215575642 | Dinh Le | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2019-12-16 |
| 1912471566 | Jiho Jang | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2019-01-17 |
| 1306371208 | Amit Mathur | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2017-04-27 |
| 1205208055 | Pooneh Ebrahimi | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2015-10-20 |
| 1215304019 | Heather Crystal Cwynar | Student in an Organized Health Care Education/Training Program | 845 S Main St, Willits, CA 95490-3915 | 2015-08-27 |
| 1114308897 | Amir Ziaee | Pharmacist | 845 S Main St, Safeway Pharmacy 0965, Willits, CA 95490-3915 | 2015-06-17 |
| 1346580966 | Elias Wassie Nuru | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2013-02-19 |
| 1497784425 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 845 S Main St, Willits, CA 95490-3915 | 2006-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679194971 | Laisenia Sau | Specialist | 180 E Barbara Lane, Willits, CA 95490 | 2020-04-28 |
| 1588160527 | Redwood Quality Management Company, Inc. | Community/Behavioral Health | 99 S. Humoldt Street #2, Willits, CA 95490 | 2018-03-30 |
| 1497063861 | Daniel Doyle | Audiologist | 474 E. Valley St., Willits, CA 95490 | 2010-09-20 |
| 1659524346 | Erika Littlefawn Tsonetokoy Coyle | Counselor | 110 E Mendocino Ave, Willits, CA 95490 | 2008-10-28 |
| 1912180548 | Paul F Jacobson | Marriage & Family Therapist | 221-b S. Lenore Avenue, Willits, CA 95490 | 2007-12-05 |
| 1629107735 | Mendocino County | Clinic/Center | 474 East Valley Street, Willits, CA 95490 | 2007-03-05 |
| 1821136482 | Jeff A Cramer | Marriage & Family Therapist | 99 East Humboldt Street, Willits, CA 95490 | 2007-02-02 |
| 1215098215 | Esther Judith Faber | Marriage & Family Therapist | 104 W Mendocino Ave, Willits, CA 95490 | 2006-12-13 |
| 1174684492 | Diana E Levy-peart | Chiropractor | 1225 South Main Street, Willits, CA 95490 | 2006-12-12 |
| 1396810628 | Maria Theresa Bates | Social Worker | Maria T Bates Lcsw, 660 So Main St Suite D, Willits, CA 95490 | 2006-11-21 |
| Find all providers in zip 95490 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598742132 | Little Lake Pharmacy Inc | Pharmacist | 90 S Main St, Willits, CA 95490-3526 | 2005-12-24 |
| 1437789641 | Eugene Lee | Pharmacist | 1730 S Main St, Willits, CA 95490-4405 | 2020-01-16 |
| 1215575642 | Dinh Le | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2019-12-16 |
| 1912471566 | Jiho Jang | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2019-01-17 |
| 1740758036 | Jared Edan Cruz | Pharmacist | 3 Marcela Dr Ste B, Willits, CA 95490-5769 | 2018-11-05 |
| 1043794753 | Lyra Cavada | Pharmacist | 1730 S Main St, Willits, CA 95490-4405 | 2018-09-18 |
| 1114431848 | Frank A Braverman | Pharmacist | 3 Marcela Dr, Willits, CA 95490-5769 | 2017-11-16 |
| 1306371208 | Amit Mathur | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2017-04-27 |
| 1528514478 | Rahel Negash | Pharmacist | 1 Marcela Drive, Pharmacy 2nd Floor, Willits, CA 95482 | 2016-08-31 |
| 1205208055 | Pooneh Ebrahimi | Pharmacist | 845 S Main St, Willits, CA 95490-3915 | 2015-10-20 |
| Find all providers in WILLITS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.