Healthcare Provider Details

I. General information

NPI: 1528623287
Provider Name (Legal Business Name): YREKA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 S MAIN ST
YREKA CA
96097-3319
US

IV. Provider business mailing address

748 S MAIN ST
YREKA CA
96097-3319
US

V. Phone/Fax

Practice location:
  • Phone: 530-698-0990
  • Fax:
Mailing address:
  • Phone: 530-698-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TONY IBRAHIM
Title or Position: CEO
Credential:
Phone: 530-698-0990