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PELICAN BAY STATE PRISON PHARMACY
NPI 1053946889
Pharmacy in Crescent City, CA

Active since March 12, 2020CLIA 05D0890527 · Waiver
5905 LAKE EARL DR, CRESCENT CITY, CA 95532(707) 465-1000(707) 465-9178 Get Directions Write a Review

NPPES record last updated: December 4, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 4, 2024, Mar 12, 2020 (2 updates tracked since 2020).

About Pelican Bay State Prison Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PELICAN BAY STATE PRISON PHARMACY (NPI 1053946889) is a healthcare organization registered as a pharmacy in Crescent City, California and active in the NPI registry since March 2020. The organization holds a CLIA Waiver certificate valid through June 22, 2028 and lists Pierre Caesare Saucier James, Staff Services Manager I, as its authorized official.

NPPES Registry Identity

NPI1053946889
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameCORRECTIONS AND REHABILITATION-HEADQUARTERS
Location Address5905 LAKE EARL DRCrescent City, CA 95532-0001
Mailing Address5905 Lake Earl DrCrescent City, CA 95532-0001 · (707) 465-1000 · Fax (707) 465-9178
Phone(707) 465-1000
Fax(707) 465-9178
Organization SubpartYesParent: Corrections And Rehabilitation
Authorized OfficialPierre Caesare Saucier JamesStaff Services Manager I · (510) 780-6997
Enumeration DateMarch 12, 2020
Last NPPES UpdateDecember 4, 20242 updates tracked since enumeration
NPPES CertifiedDecember 4, 2024
✔ NPI 1053946889 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
5905 LAKE EARL DR, Crescent City, CA 95532
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Other Names 1

Doing Business AsPelican Bay State Prison Pharmacy

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0890527

Pelican Bay State Prison Clinical Laboratory · Crescent City, CA
Active · expires Jun 22, 2028
CLIA Number05D0890527
Laboratory TypePrison
Certificate Effective DateJune 23, 2026
Certificate Expiration DateJune 22, 2028
Laboratory DirectorNkiruka Ndu
Laboratory Phone(707) 465-1000
Laboratory LocationPelican Bay State Prison Clinical Laboratory5905 Lake Earl Dr, Crescent City, CA 95532
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NANETTE LATIMER PHARMACIST
Pharmacist
5905 LAKE EARL DR, PHARMACY DEPARTMENT
CRESCENT CITY, CA 95532
Del Norte County (707) 465-1000
DR. MASOUMEH ZINAT RAZAVI PHD
Psychologist (Clinical)
5905 LAKE EARL DR
CRESCENT CITY, CA 95532
Del Norte County (707) 465-1000
DR. NHAN HOANG DINH PHARMD
Pharmacist
5905 LAKE EARL DR
CRESCENT CITY, CA 95532
Del Norte County (707) 495-1000
MS. CINDY J FOX L.C.S.W.
Social Worker (Clinical)
5905 LAKE EARL DR
CRESCENT CITY, CA 95532
Del Norte County (707) 465-1000
ROBERT BERNARD LEVINE PHD
Psychologist (Clinical)
5905 LAKE EARL DR
CRESCENT CITY, CA 95532
Del Norte County (707) 465-1000
DR. MELANIE S JONES ED.D., PSY.D.
Psychologist (Clinical)
5905 LAKE EARL DR
CRESCENT CITY, CA 95532
Del Norte County (707) 465-1000
DR. REGINA H RUSHE PH.D.
Psychologist (Clinical)
5905 LAKE EARL DR
CRESCENT CITY, CA 95532
Del Norte County (707) 465-1000
DR. CHRISTY EILEEN EMRICH PSYD
Psychologist (Clinical)
5905 LAKE EARL DR
CRESCENT CITY, CA 95532
Del Norte County (707) 465-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Corrections And Rehabilitation-Headquarters's NPI number?

The NPI number for Corrections And Rehabilitation-Headquarters is 1053946889. It was assigned to this organization in the NPPES registry on March 12, 2020. The provider is doing business as Pelican Bay State Prison Pharmacy.

Where is Corrections And Rehabilitation-Headquarters located?

Corrections And Rehabilitation-Headquarters is located at 5905 Lake Earl Dr, Crescent City, CA 95532. The listed phone number is (707) 465-1000.

What is Corrections And Rehabilitation-Headquarters's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Does Corrections And Rehabilitation-Headquarters hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0890527) is associated with this NPI, valid through June 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Corrections And Rehabilitation-Headquarters was last updated on December 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.