Healthcare Provider Details

I. General information

NPI: 1265365852
Provider Name (Legal Business Name): ANDREW HADDAD PHARMD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 AUTUMN CHASE CIR
STOCKTON CA
95219-2430
US

IV. Provider business mailing address

3126 AUTUMN CHASE CIR
STOCKTON CA
95219-2430
US

V. Phone/Fax

Practice location:
  • Phone: 209-204-2954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP455679
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: