Provider Demographics
NPI:1346228079
Name:BYTENDORP, DEBRA MARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:MARIE
Last Name:BYTENDORP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 SANTA FE CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5608
Mailing Address - Country:US
Mailing Address - Phone:891-462-1073
Mailing Address - Fax:831-465-1626
Practice Address - Street 1:75 NIELSON ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2468
Practice Address - Country:US
Practice Address - Phone:831-763-6440
Practice Address - Fax:831-763-6444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN8646546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist