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General NPI Number Information
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NPI Number | 1932769684
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Entity Type | Organization
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Legal Business Name | EXCEL SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 06/15/2019
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 604 N MAGNOLIA AVE STE 105
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City | CLOVIS
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State | CA
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Zip | 93611-9205
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Country | US
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Telephone | 302-229-5481
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Fax |
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Provider Business Mailing Address
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Address Line | 3338 DUNCAN AVE
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City | CLOVIS
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State | CA
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Zip | 93619-5007
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Country | US
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Telephone | 559-375-1241
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ADEOLA O EDEMA
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Credential |
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Telephone | 559-375-1241
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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