Healthcare Provider Details

I. General information

NPI: 1184885824
Provider Name (Legal Business Name): PETER DAVID CORBET-OWEN RPH CALIFORNIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SOLANO AVE SOLANO SHOPPING CENTER
VALLEJO CA
94590
US

IV. Provider business mailing address

753 MARSH CT
NAPA CA
94558-3034
US

V. Phone/Fax

Practice location:
  • Phone: 707-552-1476
  • Fax:
Mailing address:
  • Phone: 707-227-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: