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General NPI Number Information
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NPI Number | 1003000258
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Entity Type | Organization
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Legal Business Name | LODI PHARMACY INC
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 929 S CHEROKEE LN
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City | LODI
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State | CA
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Zip | 95240-4304
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Country | US
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Telephone | 209-365-7766
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Fax | 209-365-7733
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Provider Business Mailing Address
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Address Line | 929 S CHEROKEE LN
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City | LODI
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State | CA
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Zip | 95240-4304
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Country | US
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Telephone | 209-365-7766
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Fax | 209-365-7733
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Authorized Official
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Title or Position | DIRECTOR
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Name | JASPAL SAMRA
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Credential |
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Telephone | 209-365-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY49902
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License Number State | CA
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