=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992584437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAK HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2023
-----------------------------------------------------
Last Update Date | 05/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2339 W HAMMER LN STE J
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95209-2368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-477-7100
-----------------------------------------------------
Fax | 209-477-7111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2339 W HAMMER LN STE J
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95209-2368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-477-7100
-----------------------------------------------------
Fax | 209-477-7111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER / PRESIDENT
-----------------------------------------------------
Name | DR. AMIR TAJ KHAN
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 209-477-7100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------