Provider Demographics
NPI:1417483389
Name:PROGRESSIVE PHARMACY, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:209-857-4778
Mailing Address - Street 1:700 17TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1247
Mailing Address - Country:US
Mailing Address - Phone:209-857-4778
Mailing Address - Fax:209-422-6196
Practice Address - Street 1:700 17TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1248
Practice Address - Country:US
Practice Address - Phone:209-857-4778
Practice Address - Fax:209-422-6196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY556323336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY55632OtherCALIFORNIA STATE BOARD OF PHARMACY LICENSE