Provider Demographics
NPI:1780754176
Name:SIWOOD INC
Entity type:Organization
Organization Name:SIWOOD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:650-343-3651
Mailing Address - Street 1:1300 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3426
Mailing Address - Country:US
Mailing Address - Phone:650-343-3651
Mailing Address - Fax:650-343-2733
Practice Address - Street 1:1300 BROADWAY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3426
Practice Address - Country:US
Practice Address - Phone:650-343-3651
Practice Address - Fax:650-343-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0591493OtherNCPDP
CAPHA345590Medicaid
CAPHA345590Medicaid