Healthcare Provider Details

I. General information

NPI: 1417095167
Provider Name (Legal Business Name): MR. EDWARD FRUZZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CHURN CREEK RD SUITE A1
REDDING CA
96002-2532
US

IV. Provider business mailing address

3330 CHURN CREEK RD STE A1
REDDING CA
96002-2532
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-3039
  • Fax: 530-222-0337
Mailing address:
  • Phone: 530-222-3039
  • Fax: 530-222-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY324920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: