Individual
MO CHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6632 PACIFIC AVE, STOCKTON, CA 95207-1994
(209) 951-6544
(209) 478-8895
Mailing address
4544 MERCER HILL WAY, STOCKTON, CA 95212-3071
(209) 981-5480
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
149408
CA
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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