Healthcare Provider Details

I. General information

NPI: 1811751407
Provider Name (Legal Business Name): ANGEL ISMAEL TERRIQUEZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W LACEY BLVD
HANFORD CA
93230-4326
US

IV. Provider business mailing address

1085 CYPRESS LN
LEMOORE CA
93245-2542
US

V. Phone/Fax

Practice location:
  • Phone: 559-584-1896
  • Fax:
Mailing address:
  • Phone: 559-904-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: