Healthcare Provider Details

I. General information

NPI: 1639587322
Provider Name (Legal Business Name): MARIE BUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2014
Last Update Date: 07/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 N MILLIKEN AVE
ONTARIO CA
91764-5008
US

IV. Provider business mailing address

951 N MILLIKEN AVE
ONTARIO CA
91764-5008
US

V. Phone/Fax

Practice location:
  • Phone: 909-476-9083
  • Fax: 909-476-9044
Mailing address:
  • Phone: 909-476-9083
  • Fax: 909-476-9044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: