Provider Demographics
NPI:1083634885
Name:BAKERSFIELD DRUG COMPANY INC.
Entity Type:Organization
Organization Name:BAKERSFIELD DRUG COMPANY INC.
Other - Org Name:RUFENER'S ALTA VISTA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEYAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-325-8672
Mailing Address - Street 1:260 BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-3541
Mailing Address - Country:US
Mailing Address - Phone:661-325-8672
Mailing Address - Fax:661-323-1813
Practice Address - Street 1:260 BERNARD ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-3541
Practice Address - Country:US
Practice Address - Phone:661-325-8672
Practice Address - Fax:661-323-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA158370Medicaid