Healthcare Provider Details

I. General information

NPI: 1518532571
Provider Name (Legal Business Name): DELORES MURILLO-LINCOLN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELORES MORDECAI PHARMACY TECHNICIAN

II. Dates (important events)

Enumeration Date: 05/22/2021
Last Update Date: 05/22/2021
Certification Date: 05/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MARRIOTT DR FL 3
NASHVILLE TN
37214-5020
US

IV. Provider business mailing address

18726 S WESTERN AVE
GARDENA CA
90248-3813
US

V. Phone/Fax

Practice location:
  • Phone: 310-856-0800
  • Fax: 855-568-2494
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH124431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: