Provider Demographics
NPI:1760684047
Name:SHAFTER MEDICAL PHARMACY, LLC
Entity Type:Organization
Organization Name:SHAFTER MEDICAL PHARMACY, LLC
Other - Org Name:SHAFTER MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISKANDER
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-746-5600
Mailing Address - Street 1:825 CENTRAL VALLEY HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2003
Mailing Address - Country:US
Mailing Address - Phone:661-746-5600
Mailing Address - Fax:661-746-5600
Practice Address - Street 1:825 CENTRAL VALLEY HWY
Practice Address - Street 2:SUITE A
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2003
Practice Address - Country:US
Practice Address - Phone:661-746-5600
Practice Address - Fax:661-746-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485393336C0002X, 3336C0003X, 3336C0004X, 3336H0001X, 3336S0011X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6001140001Medicare NSC