Provider Demographics
NPI:1144240904
Name:AYCC PHARMACY INC
Entity Type:Organization
Organization Name:AYCC PHARMACY INC
Other - Org Name:R & M DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, AO
Authorized Official - Prefix:
Authorized Official - First Name:AHLET
Authorized Official - Middle Name:
Authorized Official - Last Name:HII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-992-2138
Mailing Address - Street 1:1115 WHITLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-0757
Mailing Address - Country:US
Mailing Address - Phone:559-992-2138
Mailing Address - Fax:559-992-5712
Practice Address - Street 1:1115 WHITLEY AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2325
Practice Address - Country:US
Practice Address - Phone:559-992-2138
Practice Address - Fax:559-992-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA533673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152879OtherPK
7588620001Medicare NSC
CABR7445883OtherDEA LICENSE
CAPHA453030Medicaid