Active NPI
Nikmala Tan, PHARMD
- Pharmacist
- Lodi, CA
National Provider Identifier
1508274945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 65685
- Practice address
- 1601 S Lower Sacramento Rd
Lodi, CA 95242-9762 - Phone
- (209) 368-6658
- Fax
- (209) 368-3907
- NPI assigned
- Jul 29, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 65685 | CA | Primary |
Addresses
Primary practice location
1601 S Lower Sacramento Rd
Lodi, CA 95242-9762
Mailing address
1601 S Lower Sacramento Rd
Lodi, CA 95242-9762
Phone (209) 368-6658
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65685 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678665600000",
"number": "1508274945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 S LOWER SACRAMENTO RD",
"city": "LODI",
"state": "CA",
"postal_code": "952429762",
"telephone_number": "209-368-6658",
"fax_number": "209-368-3907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 S LOWER SACRAMENTO RD",
"city": "LODI",
"state": "CA",
"postal_code": "952429762",
"telephone_number": "209-368-6658",
"fax_number": "209-368-3907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "NIKMALA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-29",
"last_updated": "2023-03-13",
"certification_date": "2023-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "65685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.