Healthcare Provider Details

I. General information

NPI: 1407698574
Provider Name (Legal Business Name): TOAN DANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 12/14/2024
Certification Date: 12/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

PO BOX 580
ELK GROVE CA
95759-0580
US

V. Phone/Fax

Practice location:
  • Phone: 916-833-8206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number88281
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: