PROVERI RX LLC (NPI# 1750909040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750909040 |
| Entity Type | Organization |
| Organization Name | PROVERI RX LLC |
| Practice Address |
4873 West Ln Ste B Stockton CA 95210-4548 |
| Mailing Address |
5713 N Pershing Ave # A3 Stockton CA 95207-4942 |
| Practice Telephone | 8053003584 |
| Mailing Telephone | 2094887770 |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |
| Authorized Official Name | DAVIS THANH TRAN (OWNER) |
| Authorized Official Telephone | 8053003584 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Proveri Family Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457913808 | Proveri Rx LLC | Pharmacy | 5713 N Pershing Ave # A3, Stockton, CA 95207-4942 | 2019-07-06 |
| 1821619537 | Proveri Rx LLC | Pharmacy | 5713 N Pershing Ave # A3, Stockton, CA 95207-4942 | 2020-05-04 |
| Street Address |
4873 WEST LN STE B |
| City | STOCKTON |
| State | CA |
| Zip Code | 95210-4548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225592058 | West Lane Clinic Rx LLC | Pharmacy | 4873 West Ln Ste B, Stockton, CA 95210-4548 | 2019-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063021970 | Leslie Jazmin Marin | Student in an Organized Health Care Education/Training Program | 7109 Danny Dr, Stockton, Stockton, CA 95210 | 2020-07-27 |
| 1043866692 | Alexis Thomasson | Behavior Technician | 7109 Danny Drive, Stockton, CA 95210 | 2019-08-09 |
| 1821651324 | Maria Guadalupe Toledo | Lactation Consultant, Non-RN | 7912 Hammer Lane, Stockton, CA 95210 | 2019-04-19 |
| 1508226440 | Active Life Adult Day Care, Inc. | Clinic/Center | 7209 Tam O'shanter Dr., Stockton, CA 95210 | 2016-03-04 |
| 1548631260 | Rachel Standley | Substance Abuse Rehabilitation Facility | 8017 El Cajon St, Stockton, CA 95210 | 2015-10-08 |
| 1225435308 | Active Life Medical Produtcs Inc | Durable Medical Equipment & Medical Supplies | 611 W Grider Way, Stockton, CA 95210 | 2014-12-04 |
| 1942633318 | Kimberly Ruiz Dizon | Physician Assistant | 1530 E Hammer Ln, Stockton, CA 95210 | 2013-08-20 |
| 1285920983 | Supplemental Health Care | Preferred Provider Organization | 8425 Kiltie Wy, Stockton, CA 95210 | 2011-06-22 |
| 1770807901 | Stockton Medical Weight Loss Center Inc | Internal Medicine | 1801 E. March Lane, Suite 400d, Stockton, CA 95210 | 2010-03-17 |
| 1699911412 | Pratap Krishna Anne | Pharmacist | 1801 E.march Ln, Suite:b280, Bjrx, Stockton, CA 95210 | 2008-12-29 |
| Find all providers in zip 95210 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700409992 | Tin Enterprise LLC | Pharmacy | 678 N Wilson Way Ste 14, Stockton, CA 95205-4200 | 2020-05-21 |
| 1225592058 | West Lane Clinic Rx LLC | Pharmacy | 4873 West Ln Ste B, Stockton, CA 95210-4548 | 2019-01-25 |
| 1285173104 | Bruce and Lee Inc | Pharmacy | 73 W March Lane Ste D, Stockton, CA 95207-5726 | 2017-02-13 |
| 1588802748 | Woods Supermarket Inc | Pharmacy | 1109 South St, Stockton, MO 65785-9456 | 2009-01-27 |
| 1265580864 | Kaiser Foundation Health Plan Inc | Pharmacy | 7373 West Ln Fl 1, Stockton, CA 95210-3377 | 2007-01-08 |
| 1760530406 | Kaiser Foundation Health Plan Inc | Pharmacy | 7373 West Ln Fl 2, Stockton, CA 95210-3377 | 2007-01-08 |
| 1225120314 | Fremont Center Pharmacy | Pharmacy | 2525 E Fremont St, Stockton, CA 95205-3906 | 2006-09-28 |
| 1417052937 | Douglas Earl Bennett | Pharmacy | 2005 E Mariposa Rd, Stockton, CA 95205-7735 | 2006-09-13 |
| 1326150319 | Califormacy Inc | Pharmacy | 3526 Manthey Rd, Ste H, Stockton, CA 95206-5301 | 2006-08-31 |
| 1396855904 | Costco Wholesale Corporation | Pharmacy | 1616 E Hammer Ln, Stockton, CA 95210 | 2006-08-30 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.