Provider Demographics
NPI:1184744070
Name:AHLSTROM, IRENE (PHARM D)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:AHLSTROM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 GOODFELLOW AVE.
Mailing Address - Street 2:15
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3307
Mailing Address - Country:US
Mailing Address - Phone:925-833-7500
Mailing Address - Fax:925-833-7595
Practice Address - Street 1:5701 8TH ST
Practice Address - Street 2:CAMP PARKS
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3305
Practice Address - Country:US
Practice Address - Phone:925-833-7500
Practice Address - Fax:925-833-7595
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist