Provider Demographics
NPI:1609077932
Name:WIENTJES, BARBARA ALICE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ALICE
Last Name:WIENTJES
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:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:WOODACRE
Mailing Address - State:CA
Mailing Address - Zip Code:94973-0536
Mailing Address - Country:US
Mailing Address - Phone:415-454-1451
Mailing Address - Fax:415-454-2865
Practice Address - Street 1:121 TUNSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2616
Practice Address - Country:US
Practice Address - Phone:415-454-1451
Practice Address - Fax:415-454-2865
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 39784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist