Healthcare Provider Details

I. General information

NPI: 1386934685
Provider Name (Legal Business Name): ROBERT SARGISIAN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N GOLDEN STATE BLVD
TURLOCK CA
95380-3952
US

IV. Provider business mailing address

3371 COLORADO AVE
TURLOCK CA
95382-8126
US

V. Phone/Fax

Practice location:
  • Phone: 209-634-5831
  • Fax: 209-632-9008
Mailing address:
  • Phone: 209-669-5731
  • Fax: 209-632-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: