Healthcare Provider Details

I. General information

NPI: 1407926314
Provider Name (Legal Business Name): KALINA S COVER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6331 OAKDALE RD
RIVERBANK CA
95367-9646
US

IV. Provider business mailing address

2342 DAKOTA AVE
MODESTO CA
95358-9781
US

V. Phone/Fax

Practice location:
  • Phone: 209-869-9055
  • Fax:
Mailing address:
  • Phone: 209-521-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: