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Provider Information for 1649302803


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BUKER COLSON MEDICINE CHEST

Organization Subpart: NO

NPI: 1649302803
Last Updated: 2020-08-22
Certification Date:

Details

NameValue
NPI1649302803
Enumeration Date2007-03-12
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Dr. JACK ARTHUR RUSTIGAN pharm. d.
Title: owner
Phone: 5592374171
Mailing Address 1300 N FRESNO ST
FRESNO, CA 93703
United States

Phone: 559-237-4171 | Fax:
 
Primary Practice Address 1300 N FRESNO ST
FRESNO, CA 93703-3845
United States

Phone: 559-237-4171 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)CA0550601ncpdp
MEDICAIDCApha390520
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyCAphy39052