MEDICARE: WOODBRIDGE PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1003801739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODBRIDGE PHARMACY

Provider Business Mailing Address
First Line	:	2401 W TURNER RD
Second Line	:	SUITE 290
City	:	LODI
State	:	CA
Zip	:	95242-2182
Country	:	US
Telephone Number	:	209-365-9200
Fax Number	:	209-365-9400

Provider Business Practice Location Address
First Line	:	2401 W TURNER RD
Second Line	:	SUITE 290
City	:	LODI
State	:	CA
Zip	:	95242-2182
Country	:	US
Telephone Number	:	209-365-9200
Fax Number	:	209-365-9400

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MR. ZAMAN KHAN
Credential	:	PHARM.D
Telephone Number	:	209-365-9200

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/22/2020

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Directions to “WOODBRIDGE PHARMACY ” Practice Location

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