Healthcare Provider Details

I. General information

NPI: 1194717207
Provider Name (Legal Business Name): ADOKIYE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14829 7TH ST STE E
VICTORVILLE CA
92395-4009
US

IV. Provider business mailing address

14829 7TH ST STE E
VICTORVILLE CA
92395-4009
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-3518
  • Fax: 760-245-1662
Mailing address:
  • Phone: 760-245-3518
  • Fax: 760-245-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46329
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NIMI MCCOY
Title or Position: PHARMACIST
Credential: RPH
Phone: 760-245-3518