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General NPI Number Information
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NPI Number | 1093940652
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Entity Type | Individual
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Provider Name | MR. ALAN DALE WITHERELL
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Gender | Male
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 9001 STOCKDALE HWY STE 28HC
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City | BAKERSFIELD
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State | CA
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Zip | 93311-1022
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Country | US
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Telephone | 661-654-3304
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Fax | 661-654-2573
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Provider Business Mailing Address
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Address Line | 10503 FISICHELLA LN
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City | BAKERSFIELD
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State | CA
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Zip | 93314-8147
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Country | US
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Telephone | 661-873-5190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 58428
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 58428
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License Number State | CA
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