Paqinc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

50420 Issued in CA

Legal business name

PAQINC

Practice address

1409 S Airport Way
Stockton, CA 95206-2319

Phone

(209) 939-9790

NPI assigned

Jan 19, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wade L. Fullmer, RPH.

Title

Pharmacist/Pic

Phone

(209) 939-0376

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Rancho San Miguel Pharmacy #21 Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305244800000",
    "number": "1073818258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 S AIRPORT WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952062319",
            "telephone_number": "209-939-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 S AIRPORT WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952062319",
            "telephone_number": "209-939-9790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAQINC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2011-05-13",
        "status": "A",
        "authorized_official_last_name": "FULLMER",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PHARMACIST/PIC",
        "authorized_official_telephone_number": "209-939-0376",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "30915",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "50420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY BOARD LICENSE",
            "identifier": "50420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rancho San Miguel Pharmacy #21",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ravi R Pankhaniya, M.D.
• Ravneet Kaur Pannu
• Panthers Limited Liability Co
• Michael Robert Panzer, DDS
• Mary Karen Papagolos, LMFT
• Alejandra Perez Parada
• Monique Paradela
• Sadichchha Parajuli
• Paramjit K. Gill, M.D., Inc.
• Dimple Parashar

• Community/Retail Pharmacy in Stockton, CA
• Providers in Stockton, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.