Provider Demographics
NPI:1093827917
Name:HINAS MERCY SOUTHWEST PHARMACY INC
Entity Type:Organization
Organization Name:HINAS MERCY SOUTHWEST PHARMACY INC
Other - Org Name:HINAS HOMECARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-664-7979
Mailing Address - Street 1:9508 STOCKDALE HWY
Mailing Address - Street 2:STE130
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3622
Mailing Address - Country:US
Mailing Address - Phone:661-664-7979
Mailing Address - Fax:661-847-0181
Practice Address - Street 1:9508 STOCKDALE HWY
Practice Address - Street 2:STE130
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3622
Practice Address - Country:US
Practice Address - Phone:661-664-7979
Practice Address - Fax:661-847-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
CAPHY466403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112675OtherPK
CAPHA466400Medicaid
2112675OtherPK