Provider Demographics
NPI:1013917483
Name:HERNDON HEALTHCARE, INC.
Entity Type:Organization
Organization Name:HERNDON HEALTHCARE, INC.
Other - Org Name:HERNDON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:TAYIAN
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-297-9002
Mailing Address - Street 1:1827 E. FIR AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-297-9002
Mailing Address - Fax:559-297-6838
Practice Address - Street 1:1827 E. FIR AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-297-9002
Practice Address - Fax:559-297-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44976333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA449760Medicaid
CAZZZ07884ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ07884ZOtherBLUE SHIELD OF CALIFORNIA