Fred P Besio Cloverdale Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY365300 Issued in CA

Legal business name

FRED P BESIO CLOVERDALE PHARMACY

Doing business as

Cloverdale Pharmacy

Practice address

790 S Cloverdale Blvd
Cloverdale, CA 95425-4010

Phone

(707) 894-4414

Fax

(707) 894-9379

NPI assigned

Aug 31, 2006

Last updated

Jul 11, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Fred Paul Besio, RPHNPI 1104062801

Title

Owner/Pharmacist

Phone

(707) 894-4414

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Cloverdale Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fred Paul Besio, RPH

  • Community/Retail Pharmacy
  • Cloverdale, CA
  • NPI 1104062801
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341964800000",
    "number": "1386755940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 S CLOVERDALE BLVD",
            "city": "CLOVERDALE",
            "state": "CA",
            "postal_code": "954254010",
            "telephone_number": "707-894-4414",
            "fax_number": "707-894-9379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 S CLOVERDALE BLVD",
            "city": "CLOVERDALE",
            "state": "CA",
            "postal_code": "954254010",
            "telephone_number": "707-894-4414",
            "fax_number": "707-894-9379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED P BESIO CLOVERDALE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-07-11",
        "status": "A",
        "authorized_official_last_name": "BESIO",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "707-894-4414",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY365300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA365300",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "0505529",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cloverdale Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Grant
• Ensign Cloverdale LLC (Cloverdale Healthcare Center)
• Amanda Farrar, MSW, LCSW
• Neftaly Magallanes Feliciano, PPS COUNSELING
• Dennis Allen Minas Fito, MD
• Kendall Galvez, FNP
• Kevin Joseph Garvin, DDS
• Mark William Garwah, DC
• Carolyn Gibbs Rankin, LMFT
• Cynthia Gorton, LMFT

• Community/Retail Pharmacy in Cloverdale, CA
• Providers in Cloverdale, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.