Healthcare Provider Details

I. General information

NPI: 1649302803
Provider Name (Legal Business Name): BUKER COLSON MEDICINE CHEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N FRESNO ST
FRESNO CA
93703-3845
US

IV. Provider business mailing address

1300 N FRESNO ST
FRESNO CA
93703
US

V. Phone/Fax

Practice location:
  • Phone: 559-237-4171
  • Fax:
Mailing address:
  • Phone: 559-237-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY39052
License Number StateCA

VIII. Authorized Official

Name: DR. JACK ARTHUR RUSTIGAN
Title or Position: OWNER
Credential: PHARM. D.
Phone: 559-237-4171