Provider Demographics
NPI:1942414867
Name:BIDULA, ELIZABETH LESLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LESLIE
Last Name:BIDULA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 VIA COLINAS
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5003
Mailing Address - Country:US
Mailing Address - Phone:805-496-4208
Mailing Address - Fax:
Practice Address - Street 1:221 E HARVARD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3315
Practice Address - Country:US
Practice Address - Phone:805-525-4014
Practice Address - Fax:805-525-5864
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist