MEDICARE: KERRI WU PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	82353	CA

General Provider Information

NPI Number	:	1629680590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI WU PHARMD

Provider Business Mailing Address
First Line	:	41 BRENTFORD CT
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 HARBOR BLVD
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93001-3904
Country	:	US
Telephone Number	:	916-667-2857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	09/28/2020

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