Healthcare Provider Details

I. General information

NPI: 1720343494
Provider Name (Legal Business Name): MICHAEL DOLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 N THOMPSON AVE
CLOVIS CA
93619-9017
US

IV. Provider business mailing address

8735 N THOMPSON AVE
CLOVIS CA
93619-9017
US

V. Phone/Fax

Practice location:
  • Phone: 559-999-1780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: