Provider Demographics
NPI:1407968498
Name:JAMES' MERCY SOUTHWEST PHARMACY, INC.
Entity Type:Organization
Organization Name:JAMES' MERCY SOUTHWEST PHARMACY, INC.
Other - Org Name:HINA'S MERCY SOUTHWEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FENG
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:864-529-7419
Mailing Address - Street 1:500 OLD RIVER RD SUITE 125
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-663-0977
Mailing Address - Fax:661-663-0991
Practice Address - Street 1:500 OLD RIVER RD SUITE 125
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311
Practice Address - Country:US
Practice Address - Phone:661-663-0977
Practice Address - Fax:661-663-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336S0011X
CAPHY415313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA415310Medicaid
CA207976933Medicaid
2066047OtherPK