Healthcare Provider Details

I. General information

NPI: 1043172737
Provider Name (Legal Business Name): MELODY YEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E MAGNOLIA ST
STOCKTON CA
95202-1846
US

IV. Provider business mailing address

6916 PENINSULA WAY
ELK GROVE CA
95758-6317
US

V. Phone/Fax

Practice location:
  • Phone: 209-687-5490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH91555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: