Healthcare Provider Details

I. General information

NPI: 1710013636
Provider Name (Legal Business Name): KAWEAH DELTA EMPLOYEE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W WILLOW AVE STE B
VISALIA CA
93291-6102
US

IV. Provider business mailing address

602 W WILLOW AVE STE B
VISALIA CA
93291-6102
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-2920
  • Fax: 559-635-4142
Mailing address:
  • Phone: 559-624-2920
  • Fax: 559-635-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHE47013
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RYAN GATES
Title or Position: OUTPATIENT PHARMACY MANAGER
Credential: RPH
Phone: 559-624-2920