Provider Demographics
NPI:1225404999
Name:MYMED PHARMACY INC
Entity Type:Organization
Organization Name:MYMED PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBINA
Authorized Official - Middle Name:CHANDHOK
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-325-6633
Mailing Address - Street 1:7141 N CEDAR AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3327
Mailing Address - Country:US
Mailing Address - Phone:559-325-6633
Mailing Address - Fax:559-325-6652
Practice Address - Street 1:7141 N CEDAR AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3327
Practice Address - Country:US
Practice Address - Phone:559-681-8053
Practice Address - Fax:559-325-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225404999Medicaid