POKERVILLE DRUG NPI 1013928605

NPI Information

NPI: 1013928605
Provider Name: POKERVILLE DRUG
Classification: Pharmacy - 3336C0003X
Specialization: Community/Retail Pharmacy
Entity Type: Organization
Address: 18170 HWY 49
SUITE A
PLYMOUTH, CA
ZIP 95669
Phone: (209) 245-3784

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NPI Details

POKERVILLE DRUG is a community/retail pharmacy pharmacy in Plymouth, CA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. POKERVILLE DRUG NPI is 1013928605. The provider is registered as an organization entity type.

The provider's business location address is:

18170 HWY 49
SUITE A
PLYMOUTH, CA
ZIP 95669
Phone: (209) 245-3784
Fax: (209) 245-4146

The provider's authorized official is Paul Wesseler .
The authorized official title is Owner and has the following contact phone number (209) 245-3784.

The enumeration date for this NPI number is 8/10/2006 and was last updated on 2/19/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	3336C0003X	Pharmacy	Community/Retail Pharmacy	PHY39679	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	PHA396790	MEDICAID	CALIFORNIA
2	4013410001	MEDICARE NSC
3	0553013	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
4	0553013	OTHER		OTHER ID NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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