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General NPI Number Information
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NPI Number | 1316506306
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Entity Type | Individual
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Provider Name | JODIE FALLOWS RPH
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Gender | Female
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 1979 PEABODY RD
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City | VACAVILLE
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State | CA
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Zip | 95687-6288
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Country | US
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Telephone | 707-452-0145
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Fax | 707-452-0183
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Provider Business Mailing Address
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Address Line | 2586 MARGARET LN
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City | BRENTWOOD
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State | CA
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Zip | 94513-5177
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Country | US
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Telephone | 925-628-6049
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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 | 76669
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License Number State | CA
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