Provider Demographics
NPI:1902214943
Name:RAZON, CHIA
Entity Type:Individual
Prefix:
First Name:CHIA
Middle Name:
Last Name:RAZON
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 1:255 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1880
Mailing Address - Country:US
Mailing Address - Phone:916-209-5176
Mailing Address - Fax:916-209-5176
Practice Address - Street 1:255 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1880
Practice Address - Country:US
Practice Address - Phone:916-209-5176
Practice Address - Fax:916-209-5176
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist