Healthcare Provider Details

I. General information

NPI: 1679751523
Provider Name (Legal Business Name): SHEILA DUYKA PHIPPS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEILA DUYKA YOUNG R.PH.

II. Dates (important events)

Enumeration Date: 02/02/2008
Last Update Date: 02/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E CHURCH ST
SANTA MARIA CA
93454-5906
US

IV. Provider business mailing address

4061 SARA CT
SANTA MARIA CA
93455-3147
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3459
  • Fax:
Mailing address:
  • Phone: 805-937-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number58301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: