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NPI Code Detail

MEDICARE: POULTER ENTERPRISES INC

MEDICARE: POULTER ENTERPRISES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacyPHY22183CA
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20566577OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1386738789
Entity Type Code : Organization
Provider Name (Legal Business Name) : POULTER ENTERPRISES INC
Provider Business Mailing Address
First Line : 1624 PUENTE AVE
Second Line :
City : BALDWIN PARK
State : CA
Zip : 91706-5952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1624 PUENTE AVE
Second Line :
City : BALDWIN PARK
State : CA
Zip : 91706-5952
Country : US
Telephone Number : 626-960-4774
Fax Number : 626-960-4775
Authorized Official
Title or Position : THIRD PARTY PLAN COORDINATOR
Name : DENA FERMAN
Credential :
Telephone Number : 314-993-6000
Provider Enumeration Date : 10/03/2006
Last Update Date : 03/07/2023

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Directions to “POULTER ENTERPRISES INC ” Practice Location

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