Active NPI
Pauline Srioudom, PHARMD
- Pharmacist
- Fairfield, CA
National Provider Identifier
1902530850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH84021
- Practice address
- 2701 N Texas St
Fairfield, CA 94533-1204 - Phone
- (707) 428-4792
- NPI assigned
- Jul 14, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | RPH84021 | CA | Primary |
Addresses
Primary practice location
2701 N Texas St
Fairfield, CA 94533-1204
Mailing address
64 N Puente Dr
Tracy, CA 95391-1147
Phone (408) 616-9646
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 |
|---|---|---|---|
| RPH84021 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657756800000",
"number": "1902530850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "64 N PUENTE DR",
"city": "TRACY",
"state": "CA",
"postal_code": "953911147",
"telephone_number": "408-616-9646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 N TEXAS ST",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945331204",
"telephone_number": "707-428-4792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SRIOUDOM",
"first_name": "PAULINE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-14",
"last_updated": "2022-07-14",
"certification_date": "2022-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "RPH84021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.