Healthcare Provider Details

I. General information

NPI: 1376351783
Provider Name (Legal Business Name): JACOB OGAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N BLACKSTONE AVE
FRESNO CA
93703-3606
US

IV. Provider business mailing address

11640 E PRINCETON AVE
SANGER CA
93657-8816
US

V. Phone/Fax

Practice location:
  • Phone: 559-445-0694
  • Fax:
Mailing address:
  • Phone: 559-978-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: