Healthcare Provider Details

I. General information

NPI: 1073906681
Provider Name (Legal Business Name): DINUBA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2015
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 N L ST
DINUBA CA
93618-2104
US

IV. Provider business mailing address

172 N L ST
DINUBA CA
93618-2104
US

V. Phone/Fax

Practice location:
  • Phone: 559-725-4525
  • Fax:
Mailing address:
  • Phone: 559-725-4525
  • Fax: 559-725-4524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number52550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EMAD MORCOS
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 559-725-4525