Healthcare Provider Details

I. General information

NPI: 1619970142
Provider Name (Legal Business Name): STEPHEN MARK WURZBURGER PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

IV. Provider business mailing address

PO BOX 150748
CAPE CORAL FL
33915-0748
US

V. Phone/Fax

Practice location:
  • Phone: 239-989-4888
  • Fax:
Mailing address:
  • Phone: 239-989-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS27398
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH35514
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7775
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: