=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922684786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL AGCAOILI YADAO PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2021
-----------------------------------------------------
Last Update Date | 03/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 E MARCH LN STE B270
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95210-6629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-395-0555
-----------------------------------------------------
Fax | 209-451-3635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9923 LIOTARD DR
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95209-4517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-471-1980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH82352
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------