Healthcare Provider Details

I. General information

NPI: 1245679067
Provider Name (Legal Business Name): MR. TOUCH UCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LN
STOCKTON CA
95210-3377
US

IV. Provider business mailing address

10619 WISHON DR
STOCKTON CA
95219-7160
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-3242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: