Organization
BUNNAUN UCH
Active
Other names
Angkor Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BUNNAUN UCH (OWNER)
(209) 888-2099
Entity
Organization
Contact information
Practice address
4555 N PERSHING AVE STE 7, STOCKTON, CA 95207-6739
(209) 888-2099
(209) 888-2105
Mailing address
4555 N PERSHING AVE STE 7, STOCKTON, CA 95207-6739
(209) 473-4706
(209) 473-7377
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY53262
CA BOARD OF PHARMACY
CA
Enumeration date
10/02/2017
Last updated
06/15/2020
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