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General NPI Number Information
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NPI Number | 1912912544
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Entity Type | Organization
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Legal Business Name | RANCHO PHARMACY
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 1367 E YOSEMITE AVE
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City | MANTECA
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State | CA
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Zip | 95336-5003
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Country | US
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Telephone | 209-823-7658
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Fax | 209-823-8552
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Provider Business Mailing Address
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Address Line | 1367 E YOSEMITE AVE
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City | MANTECA
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State | CA
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Zip | 95336-5003
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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 | OWNER
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Name | EDUARD LEINOR
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Credential |
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Telephone | 209-823-7658
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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 | PHY47157
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License Number State | CA
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