Healthcare Provider Details

I. General information

NPI: 1396354494
Provider Name (Legal Business Name): LINDSAY MICHELLE OKUBO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 MONTGOMERY DR
SANTA ROSA CA
95405-4801
US

IV. Provider business mailing address

2104 CYPRESS ST
HOLLISTER CA
95023-7553
US

V. Phone/Fax

Practice location:
  • Phone: 707-525-5335
  • Fax:
Mailing address:
  • Phone: 408-828-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH83826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: