Provider Demographics
NPI:1629557749
Name:MUTUNGA, ROSEMARY MUTINDI
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:MUTINDI
Last Name:MUTUNGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 HEMBREE LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9739
Mailing Address - Country:US
Mailing Address - Phone:707-836-7300
Mailing Address - Fax:
Practice Address - Street 1:6650 HEMBREE LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9739
Practice Address - Country:US
Practice Address - Phone:707-836-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist