Provider Demographics
NPI:1508425927
Name:SHARMA, SHYAM VEDI
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:VEDI
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 LYMAN PL
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9475
Mailing Address - Country:US
Mailing Address - Phone:209-918-8446
Mailing Address - Fax:
Practice Address - Street 1:2225 PLAZA PKWY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6215
Practice Address - Country:US
Practice Address - Phone:209-524-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist