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General NPI Number Information
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NPI Number | 1366937666
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Entity Type | Individual
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Provider Name | DENISE WOOD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 257 S FAIR OAKS AVE STE 200
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City | PASADENA
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State | CA
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Zip | 91105-4124
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Country | US
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Telephone | 800-273-7384
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Fax |
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Provider Business Mailing Address
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Address Line | 3868 MAYBELLE AVE APT 4
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City | OAKLAND
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State | CA
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Zip | 94619-2132
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Country | US
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Telephone |
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 158572
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License Number State | CA
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