Provider Demographics
NPI:1023267044
Name:DOTY, JOLENE SHARON (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:SHARON
Last Name:DOTY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 W VALPICO RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-9100
Mailing Address - Country:US
Mailing Address - Phone:209-830-0976
Mailing Address - Fax:209-830-8187
Practice Address - Street 1:599 W VALPICO RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9100
Practice Address - Country:US
Practice Address - Phone:209-830-0976
Practice Address - Fax:209-830-8187
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 61161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist