Provider Demographics
NPI:1437131075
Name:ON, TOAN YAN (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:TOAN
Middle Name:YAN
Last Name:ON
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 STOCKTON BLVD
Mailing Address - Street 2:#160
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823
Mailing Address - Country:US
Mailing Address - Phone:916-391-7210
Mailing Address - Fax:916-391-7230
Practice Address - Street 1:6830 STOCKTON BLVD
Practice Address - Street 2:#160
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-391-7210
Practice Address - Fax:916-391-7230
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA458960Medicaid
CAPHA458960Medicaid
CA4693520001Medicare ID - Type Unspecified