Organization
NADA VICIJAN
Active
Other names
west modesto pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NADA VICIJAN (PHARMACIST)
(209) 529-0325
Entity
Organization
Contact information
Practice address
314 I ST, MODESTO, CA 95351-2826
(209) 529-0325
(209) 529-0333
Mailing address
314 I ST, MODESTO, CA 95351-2826
(209) 529-0325
(209) 529-0333
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
52073
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649285255
—
CA
01
—
2152349
PK
—
Enumeration date
07/30/2006
Last updated
10/05/2016
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