Provider Demographics
NPI:1508186560
Name:SORENSON, DALE THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:THOMAS
Last Name:SORENSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-8866
Mailing Address - Country:US
Mailing Address - Phone:530-415-0671
Mailing Address - Fax:530-755-3942
Practice Address - Street 1:1590 BUTTE HOUSE RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2237
Practice Address - Country:US
Practice Address - Phone:530-755-3846
Practice Address - Fax:530-755-3942
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27226OtherSTATE LICENSE