Organization
DEWITTS DRUG STORE L P
Active
Other names
DEWITTS DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE DAVIS (PARTNER/ACCOUNTING)
(559) 665-4494
Entity
Organization
Contact information
Practice address
407 ROBERTSON BLVD, CHOWCHILLA, CA 93610-2846
(559) 665-4494
(559) 665-3632
Mailing address
12605 APPALOOSA RD, MADERA, CA 93636-8354
(559) 645-6275
(559) 645-7007
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY40751
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0530407
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA407510
—
CA
Enumeration date
03/20/2007
Last updated
01/17/2013
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