Healthcare Provider Details

I. General information

NPI: 1750589115
Provider Name (Legal Business Name): BILL W FLYNN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W. CECIL AVE
DELANO CA
93215
US

IV. Provider business mailing address

1415 ENSLEY DR
BAKERSFIELD CA
93312-4657
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-6355
  • Fax: 661-721-6323
Mailing address:
  • Phone: 661-588-9627
  • Fax: 661-721-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: