Provider Demographics
NPI:1790792356
Name:MODEL DRUG INC
Entity Type:Organization
Organization Name:MODEL DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-897-5111
Mailing Address - Street 1:1506 DRAPER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631
Mailing Address - Country:US
Mailing Address - Phone:559-897-5111
Mailing Address - Fax:559-897-1926
Practice Address - Street 1:1506 DRAPER ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631
Practice Address - Country:US
Practice Address - Phone:559-897-5111
Practice Address - Fax:559-897-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY463803336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5522100001Medicare NSC