Provider Demographics
NPI:1851700983
Name:DOSS, MARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:DOSS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SANGUINETTI RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-6214
Mailing Address - Country:US
Mailing Address - Phone:209-533-0108
Mailing Address - Fax:
Practice Address - Street 1:1101 SANGUINETTI RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-6214
Practice Address - Country:US
Practice Address - Phone:209-533-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist