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General NPI Number Information
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NPI Number | 1336221910
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Entity Type | Organization
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Legal Business Name | VAN PHARMACY
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 4502 N PERSHING AVE #AB
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City | STOCKTON
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State | CA
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Zip | 95207
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Country | US
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Telephone | 209-478-9868
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Fax | 209-478-6930
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Provider Business Mailing Address
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Address Line | 4502 N PERSHING AVE #AB
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City | STOCKTON
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State | CA
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Zip | 95207
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Country | US
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Telephone | 209-478-9868
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Fax | 209-478-6930
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE OWNER
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Name | MRS. VAN THI HONG DANG
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Credential | RPH
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Telephone | 209-478-9868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY41834
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License Number State | CA
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