Healthcare Provider Details

I. General information

NPI: 1093229320
Provider Name (Legal Business Name): PHAST PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W COLUMBUS ST
BAKERSFIELD CA
93301-1105
US

IV. Provider business mailing address

1121 W COLUMBUS ST
BAKERSFIELD CA
93301-1105
US

V. Phone/Fax

Practice location:
  • Phone: 661-527-2030
  • Fax:
Mailing address:
  • Phone: 661-578-6500
  • Fax: 661-578-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY55546
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AYMAN MOHAMED
Title or Position: PHARMACIST IN CHARGE/OWNER
Credential: RPH
Phone: 661-578-6500