Provider Demographics
NPI:1578103958
Name:PORTERVILLE EXPRESS SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:PORTERVILLE EXPRESS SPECIALTY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISKANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-343-8855
Mailing Address - Street 1:825 CENTRAL VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2078
Mailing Address - Country:US
Mailing Address - Phone:661-343-8855
Mailing Address - Fax:661-746-4978
Practice Address - Street 1:301 E OLIVE AVE STE A
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-4871
Practice Address - Country:US
Practice Address - Phone:661-343-8855
Practice Address - Fax:661-746-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy