Healthcare Provider Details

I. General information

NPI: 1336546126
Provider Name (Legal Business Name): EXPRESS DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9902 BRIMHALL RD STE 100
BAKERSFIELD CA
93312-2801
US

IV. Provider business mailing address

PO BOX 9699
BAKERSFIELD CA
93389-9699
US

V. Phone/Fax

Practice location:
  • Phone: 661-829-7861
  • Fax: 661-829-7862
Mailing address:
  • Phone: 661-829-7861
  • Fax: 661-829-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51877
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. AMER JAWICH
Title or Position: VICE PRESIDENT
Credential:
Phone: 484-340-0990