Healthcare Provider Details

I. General information

NPI: 1316862691
Provider Name (Legal Business Name): NEETHU ANNA STEPHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S STATE HIGHWAY 49
JACKSON CA
95642-2534
US

IV. Provider business mailing address

8447 KYLER RD
ELK GROVE CA
95757-5061
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-3784
  • Fax:
Mailing address:
  • Phone: 224-602-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: