Provider Demographics
NPI:1053784694
Name:WRIGHT, BERNICE
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2765
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GUAM
Mailing Address - Zip Code:96932
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:548 SOUTH MARINE CORPS DRIVE
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GUAM
Practice Address - Zip Code:96913
Practice Address - Country:UM
Practice Address - Phone:671-646-6956
Practice Address - Fax:671-647-3549
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist