Healthcare Provider Details

I. General information

NPI: 1487237103
Provider Name (Legal Business Name): JEFFERSON PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 JEFFERSON BLVD STE A
WEST SACRAMENTO CA
95691-3389
US

IV. Provider business mailing address

1029 JEFFERSON BLVD STE A
WEST SACRAMENTO CA
95691-3389
US

V. Phone/Fax

Practice location:
  • Phone: 916-371-2022
  • Fax: 916-371-2027
Mailing address:
  • Phone: 916-371-2022
  • Fax: 916-371-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BEATLE T TRAN
Title or Position: CEO
Credential: PHARMD
Phone: 209-938-9556