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MULE CREEK STATE PRISON PHARMACY
NPI 1700412368
Pharmacy in Ione, CA

Active since March 16, 2020CLIA 05D0890381 · Waiver
4001 HWY 104, IONE, CA 95640(209) 274-4911(209) 274-6039 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 16, 2020 (2 updates tracked since 2020).

About Mule Creek State Prison Pharmacy NPPES

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

MULE CREEK STATE PRISON PHARMACY (NPI 1700412368) is a healthcare organization registered as a pharmacy in Ione, California and active in the NPI registry since March 2020. The organization holds a CLIA Waiver certificate valid through August 16, 2026 and lists Pierre Caesare Saucier James, Staff Services Manager I, as its authorized official.

NPPES Registry Identity

NPI1700412368
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameCORRECTIONS AND REHABILITATION-HEADQUARTERS
Location Address4001 HWY 104Ione, CA 95640
Mailing AddressPo Box 409099Ione, CA 95640 · (209) 274-4911 · Fax (209) 274-5039
Phone(209) 274-4911
Fax(209) 274-6039
Organization SubpartYesParent: Corrections And Rehabilitation
Authorized OfficialPierre Caesare Saucier JamesStaff Services Manager I · (510) 780-6997
Enumeration DateMarch 16, 2020
Last NPPES UpdateDecember 4, 20242 updates tracked since enumeration
NPPES CertifiedDecember 4, 2024
✔ NPI 1700412368 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.
4001 HWY 104, Ione, CA 95640
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Other Names 1

Doing Business AsMule Creek 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 05D0890381

Mule Creek State Prison · Ione, CA
Active · expires Aug 16, 2026
CLIA Number05D0890381
Laboratory TypePrison
Certificate Effective DateAugust 17, 2024
Certificate Expiration DateAugust 16, 2026
Laboratory DirectorDr. Wesley Vaughn
Laboratory Phone(209) 781-6372
Laboratory LocationMule Creek State Prison4001 Highway 104, Ione, CA 95640
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 12

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

GEORGE ARTHUR MORRIS D.D.S.
Dentist
4001 HWY 104
IONE, CA 95640
Amador County (209) 274-4911
AMANDA N WOOD
Student in an Organized Health Care Education/Training Program
4001 HWY 104
IONE, CA 95640
Amador County (209) 274-4911
JULIANNE CAITLIN SULENTA LCSW
Social Worker (Clinical)
4001 HWY 104
IONE, CA 95640
Amador County (209) 274-4911
DR. ELLEN N LING DDS
Dentist
4001 HWY 104
IONE, CA 95640
Amador County (209) 274-4911
MS. LUCY YOU HER PSY.D.
Psychologist (Clinical)
4001 HWY 104
IONE, CA 95640
Amador County (209) 274-4911
OMONIYI TEMITOPE AKINTOLA PA C
Physician Assistant (Medical)
4001 HWY 104
IONE, CA 95640
Amador County (209) 274-4911
TYLER PETERSON
Psychologist (Clinical)
4001 HWY 104
IONE, CA 95640
Amador County (209) 274-4911
DR. KHARI NELSON D.D.S.
Dentist (General Practice)
4001 HWY 104
IONE, CA 95640
Amador County (916) 601-0351

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 1700412368. It was assigned to this organization in the NPPES registry on March 16, 2020. The provider is doing business as Mule Creek State Prison Pharmacy.

Where is Corrections And Rehabilitation-Headquarters located?

Corrections And Rehabilitation-Headquarters is located at 4001 Hwy 104, Ione, CA 95640. The listed phone number is (209) 274-4911.

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 05D0890381) is associated with this NPI, valid through August 16, 2026. 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.