Healthcare Provider Details

I. General information

NPI: 1669070488
Provider Name (Legal Business Name): SHERRY SAJI GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W MAIN ST STE 14
RIPON CA
95366-3027
US

IV. Provider business mailing address

2468 SUGAR CREEK LN
MANTECA CA
95336-8338
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-4686
  • Fax:
Mailing address:
  • Phone: 209-481-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: