Healthcare Provider Details

I. General information

NPI: 1396256236
Provider Name (Legal Business Name): FOOTHILL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 AVENUE 416
OROSI CA
93647-2013
US

IV. Provider business mailing address

12800 AVENUE 416
OROSI CA
93647-2013
US

V. Phone/Fax

Practice location:
  • Phone: 559-786-3078
  • Fax: 559-564-7177
Mailing address:
  • Phone: 559-786-3078
  • Fax: 559-564-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number55572
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN RICHMOND
Title or Position: PRESIDENT
Credential:
Phone: 559-592-5222