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General NPI Number Information
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NPI Number | 1417483389
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PHARMACY, LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 700 17TH ST STE 101
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City | MODESTO
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State | CA
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Zip | 95354-1248
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Country | US
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Telephone | 209-857-4778
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Fax | 209-422-6196
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Provider Business Mailing Address
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Address Line | 700 17TH ST SUITE 101
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City | MODESTO
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State | CA
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Zip | 95354-1247
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Country | US
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Telephone | 209-857-4778
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Fax | 209-422-6196
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. MARCUS H HOWARD
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Credential | PHARM.D
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Telephone | 209-857-4778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | PHY55632
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License Number State | CA
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