NPIMap

Organization Active NPI

Kaweah Delta Employee Pharmacy

  • Community/Retail Pharmacy
  • Visalia, CA
National Provider Identifier
1710013636
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHE47013 Issued in CA
Legal business name
KAWEAH DELTA EMPLOYEE PHARMACY
Practice address
602 W Willow Ave
Ste B
Visalia, CA 93291-6102
Phone
(559) 624-2920
Fax
(559) 635-4142
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Ryan Gates, RPH
Title
Outpatient Pharmacy Manager
Phone
(559) 624-2920

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHE47013 CA Primary
Mail Order Pharmacy 3336M0002X

Addresses

Primary practice location

602 W Willow Ave
Ste B
Visalia, CA 93291-6102

Mailing address

602 W Willow Ave
Ste B
Visalia, CA 93291-6102
Phone (559) 624-2920

Other identifiers 1

IdentifierTypeStateIssuer
2113420OtherPK

Other names 1

  • Kaweah Health Employee Pharmacy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address providerenrollment@kdhcd.org

National Provider Directory

National Provider Directory
Tax ID family
Kaweah Delta District H27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

602 W Willow Ave
Ste B
Visalia, CA 93291
Phone (559) 624-2920

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1710013636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 W WILLOW AVE",
            "address_2": "STE B",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916102",
            "telephone_number": "559-624-2920",
            "fax_number": "559-635-4142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 W WILLOW AVE",
            "address_2": "STE B",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916102",
            "telephone_number": "559-624-2920",
            "fax_number": "559-635-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAWEAH DELTA EMPLOYEE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "GATES",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OUTPATIENT PHARMACY MANAGER",
        "authorized_official_telephone_number": "559-624-2920",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHE47013",
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2113420",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "providerenrollment@kdhcd.org",
            "affiliation": "N",
            "address_1": "602 W Willow Ave",
            "address_2": "STE B",
            "city": "Visalia",
            "state": "CA",
            "country_code": "US",
            "postal_code": "932916102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaweah Health Employee Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Visalia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.