MEDICARE: RX CARE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY52071	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2114207	OTHER		PK

General Provider Information

NPI Number	:	1578512471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RX CARE PHARMACY INC

Provider Business Mailing Address
First Line	:	155 S 5TH ST STE A
Second Line	:
City	:	COALINGA
State	:	CA
Zip	:	93210-1903
Country	:	US
Telephone Number	:	559-935-8833
Fax Number	:	559-935-8838

Provider Business Practice Location Address
First Line	:	155 S 5TH ST STE A
Second Line	:
City	:	COALINGA
State	:	CA
Zip	:	93210-1903
Country	:	US
Telephone Number	:	559-935-8833
Fax Number	:	559-935-8838

Authorized Official
Title or Position	:	PRESIDENT,PIC
Name	:	BEN LEE
Credential	:	PHARM.D.
Telephone Number	:	559-935-8833

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	04/10/2017

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