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General NPI Number Information
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NPI Number | 1255334702
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Entity Type | Organization
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Legal Business Name | UNITED PHARMACY
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1625 E EL MONTE WAY
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City | DINUBA
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State | CA
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Zip | 93618-1832
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Country | US
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Telephone | 559-591-6400
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Fax | 559-591-8439
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Provider Business Mailing Address
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Address Line | 1625 E EL MONTE WAY
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City | DINUBA
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State | CA
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Zip | 93618-1832
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Country | US
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Telephone | 559-591-6400
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Fax | 559-591-8439
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | EDWARD J DERDERIAN
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Credential | PHARM.D.; R.PH.
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Telephone | 559-591-6400
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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 | PHY40825
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License Number State | CA
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