Healthcare Provider Details

I. General information

NPI: 1821397480
Provider Name (Legal Business Name): MICHAEL ROONEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W POLK ST
COALINGA CA
93210-2302
US

IV. Provider business mailing address

2300 S LOCUST ST
VISALIA CA
93277-5365
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-3597
  • Fax: 559-935-5879
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: