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General NPI Number Information
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NPI Number | 1780714089
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Entity Type | Organization
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Legal Business Name | FRESNO PHARMACY, INC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 4917 E. KINGS CANYON RD. # 102
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City | FRESNO
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State | CA
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Zip | 93727
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Country | US
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Telephone | 559-255-8085
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Fax | 559-255-2342
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Provider Business Mailing Address
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Address Line | 4917 E. KINGS CANYON RD. # 102
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City | FRESNO
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State | CA
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Zip | 93727
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Country | US
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Telephone | 559-255-8085
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Fax | 559-255-2342
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Authorized Official
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Title or Position | PRESIDENT
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Name | VINH QUI LY
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Credential |
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Telephone | 559-255-8085
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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 | PHY44487
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License Number State | CA
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