Basic Information
| Provider Information | |||||||||
| NPI: | 1730673484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEI | ||||||||
| FirstName: | JOHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 FITZGERALD DR | ||||||||
| Address2: | |||||||||
| City: | PINOLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945642229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107586581 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1441 FLORIDA AVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095781211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2018 | ||||||||
| LastUpdateDate: | 09/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 76362 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.