Healthcare Provider Details

I. General information

NPI: 1366400244
Provider Name (Legal Business Name): FRESNO VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

PO BOX 94410
CLEVELAND OH
44101-4410
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax: 559-241-6496
Mailing address:
  • Phone: 702-341-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIN DENISE POTTER
Title or Position: NPI TEAM MEMBER
Credential:
Phone: 202-382-2579