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General NPI Number Information
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NPI Number | 1902444581
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Entity Type | Individual
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Provider Name | SHAWN MARTIN WEDWORTH PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2019
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Last Update Date | 12/14/2019
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Provider Practice Location Address
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Address Line | 820 WALES DR
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City | FOLSOM
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State | CA
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Zip | 95630-5546
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Country | US
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Telephone | 916-984-9222
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Fax | 916-458-8267
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Provider Business Mailing Address
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Address Line | 3740 SPRINGER RD
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City | PLACERVILLE
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State | CA
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Zip | 95667-9210
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Country | US
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Telephone | 916-397-9357
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Fax | 916-458-8267
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 47280
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License Number State | CA
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