Provider Demographics
NPI:1073677050
Name:COMMUNITY CENTER PHARMACY
Entity Type:Organization
Organization Name:COMMUNITY CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAGOPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARDD
Authorized Official - Phone:559-459-6245
Mailing Address - Street 1:2210 E ILLINOIS AVE., SUITE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2184
Mailing Address - Country:US
Mailing Address - Phone:559-459-6245
Mailing Address - Fax:559-459-3926
Practice Address - Street 1:2210 E ILLINOIS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2184
Practice Address - Country:US
Practice Address - Phone:559-459-6245
Practice Address - Fax:559-459-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY327773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0587595OtherNABP