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General NPI Number Information
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NPI Number | 1609980671
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Entity Type | Organization
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Legal Business Name | MEDICAL DENTAL PHARMACY
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 689 E NEES AVE
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City | FRESNO
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State | CA
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Zip | 93720-2106
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Country | US
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Telephone | 559-439-1190
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Fax | 559-439-1165
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Provider Business Mailing Address
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Address Line | 689 E NEES AVE
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City | FRESNO
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State | CA
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Zip | 93720-2106
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Country | US
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Telephone | 559-439-1190
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Fax | 559-439-1165
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Authorized Official
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Title or Position | CEO
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Name | DIANA SMITH
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Credential | PHARMD
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Telephone | 559-439-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY44342
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License Number State | CA
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