Organization
MEDICINE SHOPPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
300 W SHAW AVE STE 114, CLOVIS, CA 93612-3680
(559) 297-0251
(559) 297-4251
Mailing address
300 W SHAW AVE STE 114, CLOVIS, CA 93612-3680
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHY224260
CA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0575247
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/31/2006
Last updated
05/29/2008
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