Healthcare Provider Details

I. General information

NPI: 1477658797
Provider Name (Legal Business Name): THREE RIVERS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40893 SIERRA DR
THREE RIVERS CA
93271-9583
US

IV. Provider business mailing address

PO BOX 415
THREE RIVERS CA
93271-0415
US

V. Phone/Fax

Practice location:
  • Phone: 559-561-4217
  • Fax: 559-561-4168
Mailing address:
  • Phone: 559-561-4217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51549
License Number StateCA

VIII. Authorized Official

Name: DAVID STANLEY
Title or Position: RPH.
Credential: BSPHARM
Phone: 559-561-4217