Provider Demographics
NPI:1104113372
Name:WU, PATTY
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 STORY RD
Mailing Address - Street 2:T1984
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 STORY RD
Practice Address - Street 2:T1984
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1921
Practice Address - Country:US
Practice Address - Phone:408-273-0055
Practice Address - Fax:408-834-1548
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist