=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013756980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANFORD HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2024
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1870 W LACEY BLVD
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-809-6281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1841 EASY ST
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-809-6281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PIC
-----------------------------------------------------
Name | SWAPNA REDDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-809-6281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------