Provider Demographics
NPI:1558617001
Name:FOX DRUG STORE INC
Entity Type:Organization
Organization Name:FOX DRUG STORE INC
Other - Org Name:FOX DRUG STORE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-344-6945
Mailing Address - Street 1:3020 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-9507
Mailing Address - Country:US
Mailing Address - Phone:559-344-6945
Mailing Address - Fax:559-344-6947
Practice Address - Street 1:3020 SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CA
Practice Address - Zip Code:93625-9507
Practice Address - Country:US
Practice Address - Phone:559-344-6945
Practice Address - Fax:559-344-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA509803336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136308OtherPK