Healthcare Provider Details

I. General information

NPI: 1588004519
Provider Name (Legal Business Name): CAREN FAI SHUI YEE-MANGINDIN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 W MARCH LN
STOCKTON CA
95207-6200
US

IV. Provider business mailing address

660 W MARCH LN
STOCKTON CA
95207-6200
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-0891
  • Fax: 209-478-1168
Mailing address:
  • Phone: 209-478-0891
  • Fax: 209-478-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: