Healthcare Provider Details

I. General information

NPI: 1528841731
Provider Name (Legal Business Name): VICTORIA TJOK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

5240 FIORE TER APT J213
SAN DIEGO CA
92122-5638
US

V. Phone/Fax

Practice location:
  • Phone: 206-778-3242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: