Provider Demographics
NPI:1881044998
Name:FRANCO, JERRY DALE JR (CPHT)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:DALE
Last Name:FRANCO
Suffix:JR
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2196
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93613-2196
Mailing Address - Country:US
Mailing Address - Phone:559-538-8565
Mailing Address - Fax:
Practice Address - Street 1:4593 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-2540
Practice Address - Country:US
Practice Address - Phone:559-222-2472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH 69227183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician