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General NPI Number Information
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NPI Number | 1629808001
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Entity Type | Organization
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Legal Business Name | MODESTO DRUG LLC
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Dates
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Enumeration Date | 08/01/2024
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 1801 H ST STE D1
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City | MODESTO
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State | CA
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Zip | 95354-1221
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Country | US
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Telephone | 209-298-1715
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Fax | 559-369-2408
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Provider Business Mailing Address
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Address Line | 1801 H ST STE D1
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City | MODESTO
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State | CA
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Zip | 95354-1221
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Country | US
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Telephone | 209-298-1715
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Fax | 559-369-2408
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Authorized Official
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Title or Position | PHARMACY OWNER
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Name | MR. PRATAP KRISHNA ANNE
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Credential |
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Telephone | 209-298-1715
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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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