Healthcare Provider Details

I. General information

NPI: 1902420003
Provider Name (Legal Business Name): BECKER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16858 YOLO AVE
ESPARTO CA
95627
US

IV. Provider business mailing address

101 MAIN ST
WINTERS CA
95694-1930
US

V. Phone/Fax

Practice location:
  • Phone: 530-795-3721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JODIE BECKER
Title or Position: OWNER
Credential:
Phone: 916-719-0012