Provider Demographics
NPI:1821619537
Name:PROVERI RX LLC
Entity Type:Organization
Organization Name:PROVERI RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-488-7770
Mailing Address - Street 1:5713 N PERSHING AVE # A3
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4942
Mailing Address - Country:US
Mailing Address - Phone:209-488-7770
Mailing Address - Fax:
Practice Address - Street 1:5713 N PERSHING AVE # A3
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4942
Practice Address - Country:US
Practice Address - Phone:209-488-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy