Provider Demographics
NPI:1902007149
Name:NEMENZO, ELVIRA C (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:C
Last Name:NEMENZO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GLORIA CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3330
Mailing Address - Country:US
Mailing Address - Phone:415-239-1425
Mailing Address - Fax:415-239-1425
Practice Address - Street 1:3931 ALEMANY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-3292
Practice Address - Country:US
Practice Address - Phone:650-757-5175
Practice Address - Fax:650-757-5180
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144339557OtherNPI