Provider Demographics
NPI:1154824514
Name:INGRAM'S PHARMACY, LLC
Entity Type:Organization
Organization Name:INGRAM'S PHARMACY, LLC
Other - Org Name:INGRAM'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-864-7216
Mailing Address - Street 1:1703 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2807
Mailing Address - Country:US
Mailing Address - Phone:661-864-7216
Mailing Address - Fax:661-843-7368
Practice Address - Street 1:1703 27TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2807
Practice Address - Country:US
Practice Address - Phone:661-864-7216
Practice Address - Fax:661-843-7368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY557623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176109OtherPK