=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245706019
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERTO CLEMENTE GARCIA PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2018
-----------------------------------------------------
Last Update Date | 10/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 W YOSEMITE AVE
-----------------------------------------------------
City | MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93637-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-673-8172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6741 W GIBSON AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93723-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-392-7288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 79637
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------