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General NPI Number Information
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NPI Number | 1427717156
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Entity Type | Individual
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Provider Name | ELIZABETH WANDA STACHURA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 123 CALIFORNIA DR
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City | YOUNTVILLE
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State | CA
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Zip | 94599-1411
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Country | US
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Telephone | 707-944-4640
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Fax | 707-944-4629
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Provider Business Mailing Address
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Address Line | PO BOX 671
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City | WINDSOR
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State | CA
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Zip | 95492-0671
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Country | US
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Telephone | 707-322-2408
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Fax | 707-944-4628
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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 | RPH30258
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License Number State | CA
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