Healthcare Provider Details

I. General information

NPI: 1184744070
Provider Name (Legal Business Name): IRENE AHLSTROM PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 8TH ST CAMP PARKS
DUBLIN CA
94568-3305
US

IV. Provider business mailing address

6700 GOODFELLOW AVE. 15
DUBLIN CA
94568-3307
US

V. Phone/Fax

Practice location:
  • Phone: 925-833-7500
  • Fax: 925-833-7595
Mailing address:
  • Phone: 925-833-7500
  • Fax: 925-833-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: