Healthcare Provider Details

I. General information

NPI: 1982465225
Provider Name (Legal Business Name): ANTHONY GAROFALO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 HERNDON AVE
CLOVIS CA
93611-0504
US

IV. Provider business mailing address

6054 E BELLAIRE WAY
FRESNO CA
93727-7979
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-1574
  • Fax:
Mailing address:
  • Phone: 559-907-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: