Provider Demographics
NPI:1336349281
Name:WHEELER, AMBER LEANN (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LEANN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 CLARK RD.
Mailing Address - Street 2:STE.B
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969
Mailing Address - Country:US
Mailing Address - Phone:530-877-4981
Mailing Address - Fax:530-877-1048
Practice Address - Street 1:6240 CLARK RD
Practice Address - Street 2:STE.B
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4167
Practice Address - Country:US
Practice Address - Phone:530-877-4981
Practice Address - Fax:530-877-1048
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73171183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY455680Medicaid