Provider Demographics
NPI:1336477785
Name:WENTZ, IZABELLA TERESA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IZABELLA
Middle Name:TERESA
Last Name:WENTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:IZABELLA
Other - Middle Name:TERESA
Other - Last Name:NOWOSADZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:21231 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5501
Mailing Address - Country:US
Mailing Address - Phone:310-543-0108
Mailing Address - Fax:310-543-0158
Practice Address - Street 1:21231 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5501
Practice Address - Country:US
Practice Address - Phone:310-543-0108
Practice Address - Fax:310-543-0158
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60937183500000X
IL051291113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist