Provider Demographics
NPI:1932110517
Name:REEDLEY PHARMACY INC
Entity Type:Organization
Organization Name:REEDLEY PHARMACY INC
Other - Org Name:REEDLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIROW
Authorized Official - Middle Name:
Authorized Official - Last Name:SASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:556-630-6317
Mailing Address - Street 1:PO BOX 25846
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5846
Mailing Address - Country:US
Mailing Address - Phone:559-285-7616
Mailing Address - Fax:
Practice Address - Street 1:1115 G ST
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-3003
Practice Address - Country:US
Practice Address - Phone:559-638-6317
Practice Address - Fax:553-637-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY398213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA398210Medicaid
0548012OtherNCPDP PROVIDER IDENTIFICATION NUMBER