Healthcare Provider Details

I. General information

NPI: 1174695944
Provider Name (Legal Business Name): MICHELLE EDWARDS ALLEN PHARMD, BCPS, FCCM,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUTTER SANTA ROSA REGIONAL HOSPITAL DEPT. OF PHARMACY 30 MARK WEST SPRINGS ROAD
SANTA ROSA CA
95403-1436
US

IV. Provider business mailing address

416 WEST ST
SEBASTOPOL CA
95472-3715
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-4340
  • Fax: 707-541-9120
Mailing address:
  • Phone: 707-819-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number55888
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12974
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: