Provider Demographics
NPI:1255175170
Name:SHAFTER MEDICAL PHARMACY, LLC
Entity type:Organization
Organization Name:SHAFTER MEDICAL PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISKANDER
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-746-5600
Mailing Address - Street 1:825 CENTRAL VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2078
Mailing Address - Country:US
Mailing Address - Phone:661-746-5600
Mailing Address - Fax:
Practice Address - Street 1:825 CENTRAL VALLEY HWY
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2078
Practice Address - Country:US
Practice Address - Phone:661-746-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy