Healthcare Provider Details

I. General information

NPI: 1730091679
Provider Name (Legal Business Name): JOANNE RAE SUNGA BAMBA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S LOWER SACRAMENTO RD
LODI CA
95242-3635
US

IV. Provider business mailing address

2555 FLOSDEN RD SPC 40
AMERICAN CANYON CA
94503-3920
US

V. Phone/Fax

Practice location:
  • Phone: 209-333-3130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number90794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: