Healthcare Provider Details

I. General information

NPI: 1417065988
Provider Name (Legal Business Name): MARTHA W PAULI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7045 WARBLER WAY
SACRAMENTO CA
95831-2978
US

IV. Provider business mailing address

7045 WARBLER WAY
SACRAMENTO CA
95831-2978
US

V. Phone/Fax

Practice location:
  • Phone: 916-395-6010
  • Fax: 916-421-3552
Mailing address:
  • Phone: 916-395-6010
  • Fax: 916-421-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number30620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: