Provider Demographics
NPI:1407972813
Name:PEDERSEN, ELIZABETH CAROLYN (ND, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CAROLYN
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:ND, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2161
Mailing Address - Country:US
Mailing Address - Phone:805-350-1102
Mailing Address - Fax:
Practice Address - Street 1:675 PINE ST
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2161
Practice Address - Country:US
Practice Address - Phone:805-350-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74175F00000X
CA42093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered183500000XPharmacy Service ProvidersPharmacist