Healthcare Provider Details

I. General information

NPI: 1023540895
Provider Name (Legal Business Name): VIVIEN WORLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 SHAW AVE STE 105-141
CLOVIS CA
93611-4078
US

IV. Provider business mailing address

1840 SHAW AVE STE 105-141
CLOVIS CA
93611-4078
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH49825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: