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General NPI Number Information
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NPI Number | 1659856052
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Entity Type | Individual
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Provider Name | PACHAI SUSAN MOUA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 11290 DONNER PASS RD
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City | TRUCKEE
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State | CA
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Zip | 96161-4808
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Country | US
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Telephone | 530-582-7952
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Fax |
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Provider Business Mailing Address
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Address Line | 631 GOTHAM DR
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City | STOCKTON
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State | CA
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Zip | 95210-2047
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Country | US
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Telephone |
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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 | RPH79405
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License Number State | CA
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