Provider Demographics
NPI:1154835700
Name:DINUBA PHARMACY INC
Entity Type:Organization
Organization Name:DINUBA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:FAWZYREZK
Authorized Official - Last Name:MORCOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-355-7835
Mailing Address - Street 1:172 N L ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2104
Mailing Address - Country:US
Mailing Address - Phone:559-725-4525
Mailing Address - Fax:559-725-4524
Practice Address - Street 1:172 N L ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2104
Practice Address - Country:US
Practice Address - Phone:559-725-4525
Practice Address - Fax:559-725-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-18
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073906681OtherNPI