Healthcare Provider Details

I. General information

NPI: 1306175823
Provider Name (Legal Business Name): EXPRESS SERVICE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BRUNDAGE LN
BAKERSFIELD CA
93304-3203
US

IV. Provider business mailing address

102 BRUNDAGE LN
BAKERSFIELD CA
93304-3203
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-2500
  • Fax: 661-325-2828
Mailing address:
  • Phone: 661-325-2500
  • Fax: 661-325-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50150
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ISKANDER HUSSEIN
Title or Position: OWNER / COORDINATOR
Credential:
Phone: 661-746-5600