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General NPI Number Information
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NPI Number | 1184635674
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Entity Type | Organization
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Legal Business Name | JOHN D MANUELE & BANJAMIN C LEON
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 1620 S COURT ST
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City | VISALIA
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State | CA
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Zip | 93277-4962
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Country | US
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Telephone | 559-738-8800
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Fax | 559-733-2636
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Provider Business Mailing Address
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Address Line | 1620 S COURT ST
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City | VISALIA
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State | CA
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Zip | 93277-4962
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Country | US
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Telephone | 559-738-8800
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Fax | 559-733-2636
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Authorized Official
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Title or Position | OWNER
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Name | BEN LEON
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Credential |
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Telephone | 559-738-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY39863
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License Number State | CA
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