Healthcare Provider Details

I. General information

NPI: 1659120046
Provider Name (Legal Business Name): FAMILY HEALTHCARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 N 1ST ST
FRESNO CA
93726-6821
US

IV. Provider business mailing address

3425 N 1ST ST
FRESNO CA
93726-6821
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 877-960-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KERRY HYDASH
Title or Position: PRESIDENT CEO
Credential:
Phone: 559-737-4700