Healthcare Provider Details

I. General information

NPI: 1609562230
Provider Name (Legal Business Name): GREYSON ANKENMAN PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 W WALNUT AVE
VISALIA CA
93277-3475
US

IV. Provider business mailing address

4133 N DEL REY AVE
CLOVIS CA
93619-5215
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-5404
  • Fax:
Mailing address:
  • Phone: 585-520-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: