Healthcare Provider Details

I. General information

NPI: 1831237254
Provider Name (Legal Business Name): DONALD JOSEPH SHALJEAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 BROADWAY AVE
ATWATER CA
95301-3546
US

IV. Provider business mailing address

1963 EL PORTAL DR
MERCED CA
95340-1779
US

V. Phone/Fax

Practice location:
  • Phone: 209-358-5622
  • Fax:
Mailing address:
  • Phone: 209-722-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH26643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: