Provider Demographics
NPI:1568744233
Name:BOUWMEESTER, DIEDERIK-JAN FREDERICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIEDERIK-JAN
Middle Name:FREDERICK
Last Name:BOUWMEESTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8317
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-8317
Mailing Address - Country:US
Mailing Address - Phone:707-726-0377
Mailing Address - Fax:
Practice Address - Street 1:1065 S FORTUNA BLVD
Practice Address - Street 2:C/O WALGREENS PHARMACY
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3010
Practice Address - Country:US
Practice Address - Phone:707-726-0377
Practice Address - Fax:707-726-0383
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist