Healthcare Provider Details

I. General information

NPI: 1699224402
Provider Name (Legal Business Name): MARIAN MEKHAIEL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 W POPLAR AVE
PORTERVILLE CA
93257-5839
US

IV. Provider business mailing address

305 E CENTER AVE
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax: 559-737-4931
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: