Provider Demographics
NPI:1376589911
Name:COMMUNITY HEALTH ENTERPRISES INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH ENTERPRISES INC
Other - Org Name:COMMUNITY CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:559-459-3578
Mailing Address - Street 1:2210 E ILLINOIS AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2125
Mailing Address - Country:US
Mailing Address - Phone:559-459-6555
Mailing Address - Fax:559-459-2465
Practice Address - Street 1:2210 E ILLINOIS AVE STE 101
Practice Address - Street 2:STE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2184
Practice Address - Country:US
Practice Address - Phone:559-459-6555
Practice Address - Fax:559-459-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336M0002X
CAPHY327773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1997819OtherPK