Organization
STEPHEN G FISK
Active
Other names
TRINITY PROFESSIONAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN FISK RPH (OWNER)
(530) 623-3250
Entity
Organization
Contact information
Practice address
1131 MAIN ST, STE 100, WEAVERVILLE, CA 96093-0460
(530) 623-3250
(530) 623-9419
Mailing address
PO BOX 460, WEAVERVILLE, CA 96093-0460
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY45193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0560133
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA451930
—
CA
Enumeration date
11/29/2006
Last updated
10/21/2009
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