NPI 1104694371
Fairmont Pharmacy
Practice location
- Address
- 1121 W Vine St #13, Lodi, CA 95240
- Phone
- (209) 625-8633
- Fax
- (209) 625-8629
Authorised official
- Name
- Beatle Thien-Phuoc Tran
- Title
- Ceo
- Phone
- (916) 938-9556
Registered specialties
Long Term Care Pharmacy
Primary
Registry record
- NPI
- 1104694371
- Entity type
- Organization
- NPI issued
- 18 Dec 2023
- Record last updated
- 18 Dec 2023
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.