Proveri RX LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PROVERI RX LLC

Practice address

4873 West LN Ste B
Stockton, CA 95210-4548

Phone

(805) 300-3584

NPI assigned

Jul 13, 2020

Organization subpart

No

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

Authorized official

Name

Davis Thanh Tran, PHARMD

Title

Owner

Phone

(805) 300-3584

Specialties & licenses 1

Addresses

Other names 1

• Proveri Family Pharmacy Doing business as

Tax ID family

Proveri Family Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Proveri RX LLC

  • Community/Retail Pharmacy
  • Stockton, CA
  • NPI 1821619537
  NPD tax ID

Locations

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594598400000",
    "number": "1750909040",
    "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",
            "telephone_number": "209-488-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4873 WEST LN STE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952104548",
            "telephone_number": "805-300-3584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVERI RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-13",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "DAVIS",
        "authorized_official_middle_name": "THANH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-300-3584",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proveri Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Jennifer Elizabeth Ptak

• 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 Jul 13, 2020; 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.