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General NPI Number Information
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NPI Number | 1396726634
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Entity Type | Organization
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Legal Business Name | RODERICK PHARMACY GROUP INC
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 711 E MARKET ST
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City | STOCKTON
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State | CA
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Zip | 95202-3104
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Country | US
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Telephone | 209-465-1001
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Fax | 209-946-1001
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Provider Business Mailing Address
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Address Line | PO BOX 1651
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City | STOCKTON
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State | CA
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Zip | 95201-1651
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Country | US
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Telephone | 209-465-1001
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Fax | 209-946-1001
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Authorized Official
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Title or Position | CEO
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Name | DAVID RODERICK
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Credential | PHARMD
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Telephone | 209-465-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY43891
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License Number State | CA
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