Provider Demographics
NPI:1427717156
Name:STACHURA, ELIZABETH WANDA (PHARMD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:WANDA
Last Name:STACHURA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-0671
Mailing Address - Country:US
Mailing Address - Phone:707-322-2408
Mailing Address - Fax:707-944-4628
Practice Address - Street 1:123 CALIFORNIA DR
Practice Address - Street 2:
Practice Address - City:YOUNTVILLE
Practice Address - State:CA
Practice Address - Zip Code:94599-1411
Practice Address - Country:US
Practice Address - Phone:707-944-4640
Practice Address - Fax:707-944-4629
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH30258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH30258OtherCALIFORNIA STATE BOARD OF PHARMACY