Provider Demographics
NPI:1679582662
Name:FIVE PHARMS, INC.
Entity type:Organization
Organization Name:FIVE PHARMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-324-2545
Mailing Address - Street 1:2336 EYE ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4012
Mailing Address - Country:US
Mailing Address - Phone:661-323-2925
Mailing Address - Fax:661-716-0292
Practice Address - Street 1:2336 EYE STREET
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4012
Practice Address - Country:US
Practice Address - Phone:661-323-2925
Practice Address - Fax:661-716-0292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE PHARMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-07
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH37875183500000X
CAPHY471663336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA471660Medicaid
CAPHA47166Medicaid
CA4121500003Medicare NSC