Organization
IVANHOE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD J DERDERIAN PHARM.D.; R.PH. (OWNER/PHARMACIST)
(559) 798-1219
Entity
Organization
Contact information
Practice address
33060 ROAD 159, IVANHOE, CA 93235-1235
(559) 798-1219
(559) 798-0975
Mailing address
33060 ROAD 159, IVANHOE, CA 93235-1235
(559) 798-1219
(559) 798-0975
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY51138
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689927816
—
CA
01
—
5645683
NCPDP
CA
Enumeration date
10/25/2012
Last updated
12/03/2013
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