Healthcare Provider Details

I. General information

NPI: 1245691294
Provider Name (Legal Business Name): MIMOSE ZEPHIR PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVE
CORCORAN CA
93212-9715
US

IV. Provider business mailing address

1830 E SHEPHERD AVE APT 114
FRESNO CA
93720-5616
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: