Healthcare Provider Details

I. General information

NPI: 1336494806
Provider Name (Legal Business Name): GUADALUPE GOVEA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N FRESNO ST STE 224
FRESNO CA
93701-2302
US

IV. Provider business mailing address

155 N FRESNO ST STE 224
FRESNO CA
93701-2302
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6508
  • Fax: 559-499-6513
Mailing address:
  • Phone: 559-499-6508
  • Fax: 559-499-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number65652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: