Provider Demographics
NPI:1861912974
Name:OAKDALE PHARMACY
Entity type:Organization
Organization Name:OAKDALE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-322-3745
Mailing Address - Street 1:1390 W H ST STE F
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3529
Mailing Address - Country:US
Mailing Address - Phone:209-322-3745
Mailing Address - Fax:
Practice Address - Street 1:1390 W H ST STE F
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3529
Practice Address - Country:US
Practice Address - Phone:209-322-3745
Practice Address - Fax:209-322-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50734333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy