Organization
PORTERVILLE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MIKHAEL (OWNER / PIC)
(559) 793-4410
Entity
Organization
Contact information
Practice address
406 W PUTNAM AVE, PORTERVILLE, CA 93257-3321
(559) 793-4410
Mailing address
406 W PUTNAM AVE, PORTERVILLE, CA 93257-3321
(559) 306-0404
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY53909
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158309
PK
—
Enumeration date
02/12/2016
Last updated
04/09/2019
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