MEDICARE: MODEL DRUG 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
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	PHY51269	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2139162	OTHER		PK

General Provider Information

NPI Number	:	1851631097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODEL DRUG INC

Provider Business Mailing Address
First Line	:	1506 DRAPER ST
Second Line	:
City	:	KINGSBURG
State	:	CA
Zip	:	93631-1909
Country	:	US
Telephone Number	:	805-481-5111
Fax Number	:	805-481-5729

Provider Business Practice Location Address
First Line	:	911 OAK PARK BLVD
Second Line	:	SUITE 101
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3405
Country	:	US
Telephone Number	:	805-481-5111
Fax Number	:	805-481-5729

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RASMIK ZAKARIAN
Credential	:
Telephone Number	:	559-897-5111

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	12/18/2016

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Directions to “MODEL DRUG INC ” Practice Location

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