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General NPI Number Information
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NPI Number | 1528623287
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Entity Type | Organization
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Legal Business Name | YREKA PHARMACY, INC.
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 748 S MAIN ST
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City | YREKA
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State | CA
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Zip | 96097-3319
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Country | US
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Telephone | 530-698-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 748 S MAIN ST
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City | YREKA
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State | CA
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Zip | 96097-3319
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Country | US
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Telephone | 530-698-0990
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TONY IBRAHIM
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Credential |
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Telephone | 530-698-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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