Healthcare Provider Details

I. General information

NPI: 1770230260
Provider Name (Legal Business Name): JOHN ERICSON MARGALLO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ # B140
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

2112 FLAGSTONE AVE
DUARTE CA
91010-3117
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-3784
  • Fax:
Mailing address:
  • Phone: 626-478-6943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number76981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: