Healthcare Provider Details

I. General information

NPI: 1215541495
Provider Name (Legal Business Name): CHERRY PHARMACY CUTLER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40657 ROAD 128
CUTLER CA
93615-2003
US

IV. Provider business mailing address

40657 ROAD 128
CUTLER CA
93615-2003
US

V. Phone/Fax

Practice location:
  • Phone: 559-234-2112
  • Fax:
Mailing address:
  • Phone: 559-390-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. WENBO LIU
Title or Position: CEO
Credential: PHARMD
Phone: 559-390-0023