Healthcare Provider Details

I. General information

NPI: 1053865279
Provider Name (Legal Business Name): PRISCILLA MOK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 WHIPPLE RD UNION CITY B PHARMACY
UNION CITY CA
94587-1507
US

IV. Provider business mailing address

35680 BARNARD DR
FREMONT CA
94536-2513
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-4462
  • Fax:
Mailing address:
  • Phone: 510-675-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: