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General NPI Number Information
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NPI Number | 1508425927
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Entity Type | Individual
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Provider Name | SHYAM VEDI SHARMA
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Gender | Male
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 2225 PLAZA PKWY
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City | MODESTO
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State | CA
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Zip | 95350-6215
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Country | US
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Telephone | 209-524-4724
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Fax |
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Provider Business Mailing Address
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Address Line | 1565 LYMAN PL
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City | RIPON
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State | CA
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Zip | 95366-9475
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Country | US
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Telephone | 209-918-8446
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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 | 77594
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License Number State | CA
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