Healthcare Provider Details

I. General information

NPI: 1114558582
Provider Name (Legal Business Name): ALBERT WU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 CASITAS PASS RD
CARPINTERIA CA
93013-2109
US

IV. Provider business mailing address

1755 CHETAMON CT
SUNNYVALE CA
94087-5241
US

V. Phone/Fax

Practice location:
  • Phone: 805-684-0260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: