Proveri RX LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

PROVERI RX LLC

Practice address

5713 N Pershing Ave # A3
Stockton, CA 95207-4942

Phone

(888) 821-4174

NPI assigned

Jul 6, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Davis Tran, PHARMD

Title

Manager

Phone

(805) 300-3584

Specialties & licenses 1

Addresses

Other names 1

• Proveri Pharmacy Services Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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

{
    "created_epoch": "1562371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588550400000",
    "number": "1457913808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5713 N PERSHING AVE # A3",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952074942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5713 N PERSHING AVE # A3",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952074942",
            "telephone_number": "888-821-4174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVERI RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-06",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "DAVIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "805-300-3584",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proveri Pharmacy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Darlene Prom
• Bora Pronh
• Kallie Provencher, BCBA
• Alaia Provencio
• Monique Nellie Provencio
• Proveri RX LLC
• Proveri RX LLC
• Elizabeth Rose Provost, RADT
• Barbara Kaye Prunty, LCSW
• PSC Stockton Outpatient Surgery Center, LLC

• Long Term Care Pharmacy in Stockton, CA
• Providers in Stockton, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.