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General NPI Number Information
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NPI Number | 1134128655
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Entity Type | Organization
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Legal Business Name | MODERN DRUG INC
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 3250 E OLIVE AVE STE B
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City | FRESNO
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State | CA
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Zip | 93702-1023
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Country | US
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Telephone | 559-268-2547
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Fax | 559-268-0212
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Provider Business Mailing Address
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Address Line | 3250 E OLIVE AVE STE B
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City | FRESNO
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State | CA
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Zip | 93702-1023
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Country | US
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Telephone | 559-268-2547
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Fax | 559-268-0212
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Authorized Official
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Title or Position | PIC/TREASURER
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Name | KIMPHI THI LE
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Credential | RPH
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Telephone | 559-268-2547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY48897
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License Number State | CA
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