Provider Demographics
NPI:1437784436
Name:PAU, ETWINA SHARON (CPHT)
Entity Type:Individual
Prefix:
First Name:ETWINA
Middle Name:SHARON
Last Name:PAU
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 SILK CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1780
Mailing Address - Country:US
Mailing Address - Phone:401-479-6511
Mailing Address - Fax:
Practice Address - Street 1:300 TRAVIS BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3804
Practice Address - Country:US
Practice Address - Phone:401-479-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8440183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician