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General NPI Number Information
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NPI Number | 1184261356
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Entity Type | Individual
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Provider Name | KAYLA PAGE
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Gender | Female
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 571 BELLEVUE RD
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City | ATWATER
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State | CA
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Zip | 95301-2928
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Country | US
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Telephone | 209-358-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 10061 RIVER BLUFF LN
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City | STOCKTON
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State | CA
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Zip | 95209-4127
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Country | US
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Telephone | 209-518-6180
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Fax |
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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 | 81357
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License Number State | CA
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