Healthcare Provider Details

I. General information

NPI: 1932769684
Provider Name (Legal Business Name): EXCEL SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2019
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 N MAGNOLIA AVE STE 105
CLOVIS CA
93611-9205
US

IV. Provider business mailing address

3338 DUNCAN AVE
CLOVIS CA
93619-5007
US

V. Phone/Fax

Practice location:
  • Phone: 302-229-5481
  • Fax:
Mailing address:
  • Phone: 559-375-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEOLA O EDEMA
Title or Position: MANAGER
Credential:
Phone: 559-375-1241