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General NPI Number Information
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NPI Number | 1861781601
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Entity Type | Individual
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Provider Name | VICTOR JOHN STATHIS RPH
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Gender | Male
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 4994 JOE HOWARD STREET
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City | MARIPOSA
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State | CA
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Zip | 95338
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Country | US
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Telephone | 209-742-5600
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Fax | 209-742-7500
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Provider Business Mailing Address
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Address Line | 4994 JOE HOWARD STREET
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City | MARIPOSA
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State | CA
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Zip | 95338
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Country | US
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Telephone | 209-742-5600
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Fax | 209-742-7500
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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 | RPH37612
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S012735
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License Number State | AZ
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