Healthcare Provider Details

I. General information

NPI: 1912367467
Provider Name (Legal Business Name): JANE OH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 FULTON AVE
SACRAMENTO CA
95825-3603
US

IV. Provider business mailing address

6904 VILAMOURA WAY
ELK GROVE CA
95757-3420
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-3486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: