Provider Demographics
NPI:1013489400
Name:AVENAL EXPRESS PHARMACY LLC
Entity type:Organization
Organization Name:AVENAL EXPRESS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-345-6737
Mailing Address - Street 1:PO BOX 9699
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-9699
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:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy