1457661407 NPI number — ELIZABETH WITTKOP PHARMD, BCPS

Table of content: DR. ANTHONY J DIGREGORIO DDS (NPI 1952482739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457661407 NPI number — ELIZABETH WITTKOP PHARMD, BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITTKOP
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, BCPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457661407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 DIABLO CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94506-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-788-5183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 CLEMENT ST
Provider Second Line Business Practice Location Address:
PHARMACY SERVICE (119)
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94121-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-221-4810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  64769 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)