Provider Demographics
NPI:1013489400
Name:AVENAL EXPRESS PHARMACY LLC
Entity Type:Organization
Organization Name:AVENAL EXPRESS PHARMACY LLC
Other - Org Name:EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-583-1480
Mailing Address - Street 1:365 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4374
Mailing Address - Country:US
Mailing Address - Phone:559-583-1480
Mailing Address - Fax:559-583-1475
Practice Address - Street 1:317 E KINGS ST
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-1630
Practice Address - Country:US
Practice Address - Phone:559-583-1480
Practice Address - Fax:559-583-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-22
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy