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General NPI Number Information
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NPI Number | 1114373248
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Entity Type | Individual
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Provider Name | CARISSE MAMARIL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 05/07/2016
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Last Update Date | 05/07/2016
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Provider Practice Location Address
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Address Line | 1050 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90012-2102
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Country | US
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Telephone | 213-975-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 10706 VICTORY BLVD APT 213
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3859
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Country | US
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Telephone | 818-384-4058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 74496
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License Number State | CA
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