Provider Demographics
NPI:1235528118
Name:VILCHES-TRAN, ROWENA
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:VILCHES-TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OAKDALE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4592
Mailing Address - Country:US
Mailing Address - Phone:209-525-9430
Mailing Address - Fax:209-525-9440
Practice Address - Street 1:801 OAKDALE RD STE F
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4591
Practice Address - Country:US
Practice Address - Phone:209-525-9430
Practice Address - Fax:209-525-9440
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist