Healthcare Provider Details

I. General information

NPI: 1306127261
Provider Name (Legal Business Name): CHARISSE MAY C. VIVAR PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARISSE MAY V. CAROLINO PHARM.D.

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD VA NORTHERN CALIFORNIA HEALTH CARE SYSTEM 119/MCC
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

4385 WEATHERVANE WAY
ROSEVILLE CA
95747-4207
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7422
  • Fax:
Mailing address:
  • Phone: 415-990-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018777
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: