Healthcare Provider Details

I. General information

NPI: 1366937666
Provider Name (Legal Business Name): DENISE WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 S FAIR OAKS AVE STE 200
PASADENA CA
91105-4124
US

IV. Provider business mailing address

3868 MAYBELLE AVE APT 4
OAKLAND CA
94619-2132
US

V. Phone/Fax

Practice location:
  • Phone: 800-273-7384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number158572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: