Provider Demographics
NPI:1336546126
Name:EXPRESS DRUGS
Entity type:Organization
Organization Name:EXPRESS DRUGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-340-0990
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:661-829-7861
Mailing Address - Fax:661-829-7862
Practice Address - Street 1:9902 BRIMHALL RD STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2801
Practice Address - Country:US
Practice Address - Phone:661-829-7861
Practice Address - Fax:661-829-7862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPRESS DRUGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-24
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA518773336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51877OtherPHARMACY LICENSE NUMBER