Organization
NORTHWEST MEDICAL PHARMACY
Active
Other names
DBA:Northwest Medical Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A WILCOX R.PH (PRESIDENT/OWNER)
(559) 271-6370
Entity
Organization
Contact information
Practice address
7355 N PALM AVE, SUITE 100, FRESNO, CA 93711-5770
(559) 271-6370
(559) 271-6371
Mailing address
7355 N PALM AVE STE 100, FRESNO, CA 93711-5770
(559) 271-6370
(559) 271-6371
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHY40808
CA
333600000X
Pharmacy
Primary
PHY40808
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0514390
NCPDP
CA
05
—
PHA408080
—
CA
Enumeration date
10/05/2006
Last updated
02/07/2017
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