Organization
POKERVILLE DRUG
Active
Organization
POKERVILLE DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL WESSELER (OWNER)
(209) 245-3784
Entity
Organization
Contact information
Practice address
18170 HWY 49, SUITE A, PLYMOUTH, CA 95669
(209) 245-3784
(209) 245-4146
Mailing address
18170 HWY 49, SUITE A, PLYMOUTH, CA 95669
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY39679
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0553013
OTHER ID NUMBER
—
05
—
PHA396790
—
CA
Enumeration date
08/10/2006
Last updated
02/19/2008
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