Healthcare Provider Details

I. General information

NPI: 1679578298
Provider Name (Legal Business Name): J & S BIRDSONG PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W MAIN ST
EL CENTRO CA
92243-2920
US

IV. Provider business mailing address

600 W MAIN ST
EL CENTRO CA
92243-2920
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-0600
  • Fax: 760-352-0220
Mailing address:
  • Phone: 760-352-0600
  • Fax: 760-352-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY43713
License Number StateCA

VIII. Authorized Official

Name: SAMUEL BIRDSONG
Title or Position: OWNER
Credential: RPH
Phone: 760-352-0600