Provider Demographics
NPI:1295890978
Name:SEVEN 0-2 PHARMACY
Entity type:Organization
Organization Name:SEVEN 0-2 PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:559-784-4702
Mailing Address - Street 1:406 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3321
Mailing Address - Country:US
Mailing Address - Phone:559-784-4702
Mailing Address - Fax:
Practice Address - Street 1:406 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3321
Practice Address - Country:US
Practice Address - Phone:559-784-4702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-24
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH30460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY350340Medicaid
CA0583000001Medicare NSC