Provider Demographics
NPI:1225327885
Name:COREMED PHARMACY SERVICES
Entity Type:Organization
Organization Name:COREMED PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:800-853-0651
Mailing Address - Street 1:911 INDUSTRIAL WAY
Mailing Address - Street 2:SUITE G
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3121
Mailing Address - Country:US
Mailing Address - Phone:800-853-0651
Mailing Address - Fax:209-366-1818
Practice Address - Street 1:911 INDUSTRIAL WAY
Practice Address - Street 2:SUITE G
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3121
Practice Address - Country:US
Practice Address - Phone:800-853-0651
Practice Address - Fax:209-366-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50590333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50590OtherBOARD OF PHARMACY
CA50590OtherBOARD OF PHARMACY