Healthcare Provider Details

I. General information

NPI: 1538948617
Provider Name (Legal Business Name): CARISSA HUANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 FARRAGUT AVE
SAN FRANCISCO CA
94112-4005
US

IV. Provider business mailing address

171 FARRAGUT AVE
SAN FRANCISCO CA
94112-4005
US

V. Phone/Fax

Practice location:
  • Phone: 415-672-5375
  • Fax:
Mailing address:
  • Phone: 415-672-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: