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General NPI Number Information
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NPI Number | 1760455711
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Entity Type | Organization
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Legal Business Name | MODERN DRUG INC
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 3044 TULARE ST
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City | FRESNO
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State | CA
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Zip | 93721
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Country | US
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Telephone | 559-266-0701
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Fax | 559-266-2438
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Provider Business Mailing Address
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Address Line | 3044 TULARE ST
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City | FRESNO
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State | CA
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Zip | 93721
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Country | US
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Telephone | 559-266-0701
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Fax | 559-266-2438
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHAN B LUONG
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Credential | RPH
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Telephone | 559-266-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY43219
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License Number State | CA
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