=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225327885
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COREMED PHARMACY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2011
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 INDUSTRIAL WAY SUITE G
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95240-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-853-0651
-----------------------------------------------------
Fax | 209-366-1818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 911 INDUSTRIAL WAY SUITE G
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95240-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-853-0651
-----------------------------------------------------
Fax | 209-366-1818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | DR. ZAMAN KHAN
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 800-853-0651
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 50590
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------