Healthcare Provider Details

I. General information

NPI: 1730727462
Provider Name (Legal Business Name): ANN DYRENG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 LINCOLN AVE
SAN JOSE CA
95125-3016
US

IV. Provider business mailing address

1285 LINCOLN AVE
SAN JOSE CA
95125-3016
US

V. Phone/Fax

Practice location:
  • Phone: 408-781-6008
  • Fax:
Mailing address:
  • Phone: 408-280-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: