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General NPI Number Information
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NPI Number | 1598270373
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Entity Type | Individual
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Provider Name | TREVEN J SORENSEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/03/2017
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Last Update Date | 12/03/2017
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Provider Practice Location Address
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Address Line | 1449 E F ST STE 102
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City | OAKDALE
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State | CA
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Zip | 95361-9266
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Country | US
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Telephone | 209-847-4279
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Fax | 209-848-3210
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Provider Business Mailing Address
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Address Line | PO BOX 4247
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City | MODESTO
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State | CA
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Zip | 95352-4247
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Country | US
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Telephone | 208-313-6266
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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 | 77979
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License Number State | CA
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