Healthcare Provider Details

I. General information

NPI: 1760476683
Provider Name (Legal Business Name): PATRICIA CARLTON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CALIFORNIA ST
STOCKTON CA
95204-6019
US

IV. Provider business mailing address

2321 WINTERGREEN CT
LODI CA
95242-3651
US

V. Phone/Fax

Practice location:
  • Phone: 209-461-5100
  • Fax:
Mailing address:
  • Phone: 209-339-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH37034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: