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General NPI Number Information
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NPI Number | 1861912974
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Entity Type | Organization
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Legal Business Name | OAKDALE PHARMACY
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 1390 W H ST STE F
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City | OAKDALE
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State | CA
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Zip | 95361-3529
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Country | US
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Telephone | 209-322-3745
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Fax | 209-322-2052
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Provider Business Mailing Address
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Address Line | 1390 W H ST STE F
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City | OAKDALE
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State | CA
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Zip | 95361-3529
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Country | US
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Telephone | 209-322-3745
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Fax |
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Authorized Official
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Title or Position | PIC/OWNER
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Name | CHRISTEN KIM
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Credential | RPH
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Telephone | 209-322-3745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 50734
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License Number State | CA
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