Healthcare Provider Details

I. General information

NPI: 1073983144
Provider Name (Legal Business Name): BJRX PHARMACY LTC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN # 270
STOCKTON CA
95210-6629
US

IV. Provider business mailing address

1801 E MARCH LN SUITE:B270
STOCKTON CA
95210-6629
US

V. Phone/Fax

Practice location:
  • Phone: 209-451-3171
  • Fax: 209-451-3635
Mailing address:
  • Phone: 209-474-3888
  • Fax: 209-474-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY 53617
License Number StateCA

VIII. Authorized Official

Name: PRATAP ANNE
Title or Position: DIRECTOR
Credential:
Phone: 209-474-3888