Healthcare Provider Details

I. General information

NPI: 1598270373
Provider Name (Legal Business Name): TREVEN J SORENSEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1449 E F ST STE 102
OAKDALE CA
95361-9266
US

IV. Provider business mailing address

PO BOX 4247
MODESTO CA
95352-4247
US

V. Phone/Fax

Practice location:
  • Phone: 209-847-4279
  • Fax: 209-848-3210
Mailing address:
  • Phone: 208-313-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: