Healthcare Provider Details

I. General information

NPI: 1174289649
Provider Name (Legal Business Name): MARIE FAITH DEL ROSARIO APOLINARIO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

205 E CHESTNUT ST APT 5
GLENDALE CA
91205-3961
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-6763
  • Fax:
Mailing address:
  • Phone: 818-404-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85594
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number85594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: