# JEFFERSON PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528640372
- **Authorized official:** MR. BEATLE TRAN PHARMD (CEO)
- **Authorized official phone:** (209) 938-9556

## Contact information

- **Practice address:** 1029 JEFFERSON BLVD STE A, WEST SACRAMENTO, CA 95691-3389
- **Practice address phone:** (916) 371-2022
- **Practice address fax:** (916) 371-2027
- **Mailing address:** 1029 JEFFERSON BLVD STE A, WEST SACRAMENTO, CA 95691-3389
- **Mailing address phone:** (916) 371-2022
- **Mailing address fax:** (916) 371-2027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/22/2021
- **Last updated:** 04/22/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1699846774 | — | CA |