Healthcare Provider Details

I. General information

NPI: 1346594736
Provider Name (Legal Business Name): EXPRESS DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CALLOWAY DR SUIT 302
BAKERSFIELD CA
93312-2513
US

IV. Provider business mailing address

PO BOX 9699
BAKERSFIELD CA
93389-9699
US

V. Phone/Fax

Practice location:
  • Phone: 661-829-7870
  • Fax: 661-829-7873
Mailing address:
  • Phone: 661-829-7870
  • Fax: 661-829-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number51085
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51085
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number51085
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number51085
License Number StateCA

VIII. Authorized Official

Name: RAMY EBEID
Title or Position: PIC/CEO
Credential:
Phone: 661-829-7870