Provider Demographics
NPI:1528387552
Name:ARNAN, MA LOURDES PAG-ONG
Entity Type:Individual
Prefix:MRS
First Name:MA LOURDES
Middle Name:PAG-ONG
Last Name:ARNAN
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 1:1900 OAKDALE RD
Mailing Address - Street 2:APT 124
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2929
Mailing Address - Country:US
Mailing Address - Phone:209-241-6794
Mailing Address - Fax:
Practice Address - Street 1:1300 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3501
Practice Address - Country:US
Practice Address - Phone:209-847-1324
Practice Address - Fax:209-847-1392
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
CA25496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist