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General NPI Number Information
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NPI Number | 1013787092
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Entity Type | Organization
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Legal Business Name | GRIZZLY PHARMACY-CLOVIS
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 255 W HERNDON AVE STE 101
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City | CLOVIS
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State | CA
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Zip | 93612-0381
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Country | US
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Telephone | 559-324-1808
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Fax | 559-324-1876
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Provider Business Mailing Address
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Address Line | 255 W HERNDON AVE STE 101
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City | CLOVIS
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State | CA
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Zip | 93612-0381
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Country | US
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Telephone | 559-324-1808
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Fax | 559-324-1876
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Authorized Official
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Title or Position | OWNER
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Name | DREW WARTHEN
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Credential |
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Telephone | 559-324-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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