Organization
BUKER COLSON MEDICINE CHEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK ARTHUR RUSTIGAN PHARM. D. (OWNER)
(559) 237-4171
Entity
Organization
Contact information
Practice address
1300 N FRESNO ST, FRESNO, CA 93703-3845
(559) 237-4171
Mailing address
1300 N FRESNO ST, FRESNO, CA 93703
(559) 237-4171
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY39052
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0550601
NCPDP
CA
05
—
PHA390520
—
CA
Enumeration date
03/12/2007
Last updated
08/22/2020
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