Healthcare Provider Details

I. General information

NPI: 1710549506
Provider Name (Legal Business Name): YOSEMITE DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35300 HIGHWAY 41 STE 101
COARSEGOLD CA
93614-8718
US

IV. Provider business mailing address

35300 HIGHWAY 41 STE 101
COARSEGOLD CA
93614-8718
US

V. Phone/Fax

Practice location:
  • Phone: 559-692-2479
  • Fax:
Mailing address:
  • Phone: 559-692-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE BASS
Title or Position: OWNER
Credential: PHARMD
Phone: 209-382-1291