Provider Demographics
NPI:1558143537
Name:UDOTT, EMEM LAWRENCE (RPH)
Entity Type:Individual
Prefix:
First Name:EMEM
Middle Name:LAWRENCE
Last Name:UDOTT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 BEDFORD LN APT 66
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3563
Mailing Address - Country:US
Mailing Address - Phone:559-860-9345
Mailing Address - Fax:
Practice Address - Street 1:5037 E BRUNDAGE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-2907
Practice Address - Country:US
Practice Address - Phone:661-448-8148
Practice Address - Fax:661-448-8149
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist