Healthcare Provider Details

I. General information

NPI: 1154240141
Provider Name (Legal Business Name): IR SUPPLIER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 PRINCESS DR
STOCKTON CA
95209-1926
US

IV. Provider business mailing address

1331 PRINCESS DR
STOCKTON CA
95209-1926
US

V. Phone/Fax

Practice location:
  • Phone: 209-985-8858
  • Fax:
Mailing address:
  • Phone: 209-985-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JALAL KHAN
Title or Position: OWNER
Credential:
Phone: 209-985-8858