Provider Demographics
NPI:1184659963
Name:CEDAR DRUGS
Entity Type:Organization
Organization Name:CEDAR DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ST. LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:559-266-0601
Mailing Address - Street 1:4160 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-2520
Mailing Address - Country:US
Mailing Address - Phone:559-266-0601
Mailing Address - Fax:559-266-1012
Practice Address - Street 1:4160 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2520
Practice Address - Country:US
Practice Address - Phone:559-266-0601
Practice Address - Fax:559-266-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY345983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA345980Medicaid
CA1227100001Medicare ID - Type Unspecified