Healthcare Provider Details

I. General information

NPI: 1518988575
Provider Name (Legal Business Name): FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N WAYTE LN
FRESNO CA
93701-2124
US

IV. Provider business mailing address

290 N WAYTE LN
FRESNO CA
93701-2124
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4592
  • Fax: 559-459-6110
Mailing address:
  • Phone: 559-459-4592
  • Fax: 559-459-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY41924
License Number StateCA

VIII. Authorized Official

Name: DENISE WALSH
Title or Position: PHCY MGR
Credential: PHARM D
Phone: 559-459-3578