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General NPI Number Information
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NPI Number | 1750937447
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Entity Type | Organization
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Legal Business Name | SELMA PHARMACY CORP
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Dates
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Enumeration Date | 08/18/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 2132 HIGH ST
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City | SELMA
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State | CA
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Zip | 93662-3009
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Country | US
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Telephone | 917-500-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 2132 HIGH ST
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City | SELMA
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State | CA
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Zip | 93662-3009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHADY VICTOR MONIR DOUS
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Credential | RPH
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Telephone | 917-500-7020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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