Healthcare Provider Details

I. General information

NPI: 1457424830
Provider Name (Legal Business Name): JESSICA PAAG THOJ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

7428 WINNETT WAY
SACRAMENTO CA
95823-2844
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-5655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number58353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: