Healthcare Provider Details

I. General information

NPI: 1184907339
Provider Name (Legal Business Name): JAMES A BIEDENWEG BS PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ASHLAND CT
TURLOCK CA
95382-1285
US

IV. Provider business mailing address

860 ASHLAND CT
TURLOCK CA
95382-1285
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-5238
  • Fax:
Mailing address:
  • Phone: 209-667-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5955
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: