Provider Demographics
NPI:1194717207
Name:ADOKIYE ENTERPRISES
Entity type:Organization
Organization Name:ADOKIYE ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-245-3518
Mailing Address - Street 1:14829 7TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4009
Mailing Address - Country:US
Mailing Address - Phone:760-245-3518
Mailing Address - Fax:760-245-1662
Practice Address - Street 1:14829 7TH ST STE E
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4009
Practice Address - Country:US
Practice Address - Phone:760-245-3518
Practice Address - Fax:760-245-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
CAPHY463293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000155OtherPK
CAPHA463290Medicaid
CAPHA463290Medicaid