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General NPI Number Information
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NPI Number | 1144692534
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Entity Type | Individual
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Provider Name | ANCONG SHEN
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Gender | Male
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 1980 COLLEGE BLVD
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City | OCEANSIDE
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State | CA
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Zip | 92056-5939
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Country | US
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Telephone | 760-945-4676
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Fax | 760-945-5219
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Provider Business Mailing Address
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Address Line | 3639 GLEN AVE
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City | CARLSBAD
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State | CA
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Zip | 92010-5518
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Country | US
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Telephone | 760-945-4676
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Fax | 760-945-5219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 65863
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License Number State | CA
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