Healthcare Provider Details

I. General information

NPI: 1457342545
Provider Name (Legal Business Name): MERCED COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2005
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 G ST STE D
MERCED CA
95340-0978
US

IV. Provider business mailing address

3349 G ST STE D
MERCED CA
95340-0978
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-1222
  • Fax: 209-722-1212
Mailing address:
  • Phone: 209-722-1222
  • Fax: 209-722-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46938
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAULA PHUONG LE
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 209-722-1222