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General NPI Number Information
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NPI Number | 1821033143
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Entity Type | Organization
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Legal Business Name | TRI-VALLEY PHARMACY CORPORATION
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 5720 STONERIDGE MALL RD #150
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City | PLEASANTON
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State | CA
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Zip | 94588-2828
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Country | US
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Telephone | 925-463-2248
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Fax | 925-463-5615
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Provider Business Mailing Address
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Address Line | 5720 STONERIDGE MALL RD #150
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City | PLEASANTON
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State | CA
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Zip | 94588-2828
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Country | US
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Telephone | 925-463-2248
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Fax | 925-463-5615
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN FONG
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Credential | PHARM.D.
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Telephone | 925-463-2248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY47432
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License Number State | CA
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