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NPI Code Detail

MEDICARE: STOCKTON PHARMACY

MEDICARE: STOCKTON PHARMACY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0004XCompounding Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
161500OTHERCAPHARMACY LICENSE

General Provider Information

NPI Number : 1417891953
Entity Type Code : Organization
Provider Name (Legal Business Name) : STOCKTON PHARMACY
Provider Business Mailing Address
First Line : 1140 W HAMMER LN # D
Second Line :
City : STOCKTON
State : CA
Zip : 95209-3011
Country : US
Telephone Number : 209-395-0555
Fax Number : 209-451-3635
Provider Business Practice Location Address
First Line : 1140 W HAMMER LN # D
Second Line :
City : STOCKTON
State : CA
Zip : 95209-3011
Country : US
Telephone Number : 209-395-0555
Fax Number : 209-451-3635
Authorized Official
Title or Position : PHARMACY DIRECTOR
Name : MR. PRATAP KRISHNA ANNE
Credential :
Telephone Number : 209-395-0555
Provider Enumeration Date : 04/15/2026
Last Update Date : 04/15/2026

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Directions to “STOCKTON PHARMACY ” Practice Location

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