Provider Demographics
NPI:1255108593
Name:VANDER WOUDE, ALEXA GAYLE CAPULE
Entity type:Individual
Prefix:
First Name:ALEXA GAYLE
Middle Name:CAPULE
Last Name:VANDER WOUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXA GAYLE
Other - Middle Name:YAMAT
Other - Last Name:CAPULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12401 CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:LE GRAND
Mailing Address - State:CA
Mailing Address - Zip Code:95333-9717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1445 R ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-5850
Practice Address - Country:US
Practice Address - Phone:209-725-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA884471835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist