Healthcare Provider Details

I. General information

NPI: 1841722998
Provider Name (Legal Business Name): ICARE PHARMACY 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SUNNYSLOPE RD
HOLLISTER CA
95023-5784
US

IV. Provider business mailing address

920 SUNNYSLOPE RD 920 SUNNYSLOPE ROAD
HOLLISTER CA
95023-5784
US

V. Phone/Fax

Practice location:
  • Phone: 408-926-7691
  • Fax: 408-926-7697
Mailing address:
  • Phone: 408-926-7691
  • Fax: 408-926-7697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY55515
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LINH NGUYEN
Title or Position: PIC
Credential:
Phone: 408-398-9071