=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366195695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE MWANGALE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2022
-----------------------------------------------------
Last Update Date | 04/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7535 N PALM AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93711-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-797-3543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2365 PROMONTORY DR
-----------------------------------------------------
City | SIGNAL HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90755-3860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-858-0751
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 44540
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------