Healthcare Provider Details

I. General information

NPI: 1467603381
Provider Name (Legal Business Name): SHAYNE STRASSER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 E F ST SUITE 102
OAKDALE CA
95361-9265
US

IV. Provider business mailing address

1449 E F ST SUITE 102
OAKDALE CA
95361-9265
US

V. Phone/Fax

Practice location:
  • Phone: 209-847-4279
  • Fax: 209-848-3210
Mailing address:
  • Phone: 209-847-4279
  • Fax: 209-848-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42884
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10189
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: