Provider Demographics
NPI:1689113656
Name:CALDERON, WENDA
Entity Type:Individual
Prefix:
First Name:WENDA
Middle Name:
Last Name:CALDERON
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 1:27619 NUGGET DR
Mailing Address - Street 2:#3
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-4255
Mailing Address - Country:US
Mailing Address - Phone:770-598-1715
Mailing Address - Fax:
Practice Address - Street 1:37160 47TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4450
Practice Address - Country:US
Practice Address - Phone:661-236-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist