Healthcare Provider Details

I. General information

NPI: 1851786057
Provider Name (Legal Business Name): KEVIN MAQ WU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 HOPYARD RD
PLEASANTON CA
94588-5241
US

IV. Provider business mailing address

1165 ARNOLD DR
MARTINEZ CA
94553-4104
US

V. Phone/Fax

Practice location:
  • Phone: 925-846-8345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: