Healthcare Provider Details

I. General information

NPI: 1831439967
Provider Name (Legal Business Name): ADVANCED FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5191 N 6TH ST
FRESNO CA
93710-7502
US

IV. Provider business mailing address

5191 N 6TH ST
FRESNO CA
93710-7502
US

V. Phone/Fax

Practice location:
  • Phone: 559-222-8303
  • Fax: 559-222-1082
Mailing address:
  • Phone: 559-222-8303
  • Fax: 559-222-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY 51992
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY 51992
License Number StateCA

VIII. Authorized Official

Name: MR. RICHARD HALL
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 559-222-8303