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General NPI Number Information
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NPI Number | 1578103958
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Entity Type | Organization
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Legal Business Name | PORTERVILLE EXPRESS SPECIALTY PHARMACY, LLC
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 301 E OLIVE AVE STE A
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City | PORTERVILLE
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State | CA
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Zip | 93257-4871
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Country | US
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Telephone | 661-343-8855
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Fax | 661-746-4978
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Provider Business Mailing Address
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Address Line | 825 CENTRAL VALLEY HWY
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City | SHAFTER
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State | CA
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Zip | 93263-2078
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Country | US
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Telephone | 661-343-8855
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Fax | 661-746-4978
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Authorized Official
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Title or Position | PRESIDENT
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Name | ISKANDER HUSSEIN
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Credential | RPH
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Telephone | 661-343-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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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 | 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 #4
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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 #5
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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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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