Healthcare Provider Details

I. General information

NPI: 1134660087
Provider Name (Legal Business Name): ANGELA JACKAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA SZE

II. Dates (important events)

Enumeration Date: 03/12/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 N CORPORATE DR
FRESNO CA
93720-8401
US

IV. Provider business mailing address

PO BOX 26782
FRESNO CA
93729-6782
US

V. Phone/Fax

Practice location:
  • Phone: 559-912-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: