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General NPI Number Information
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NPI Number | 1396008645
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Entity Type | Individual
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Provider Name | MARK A ITUAH RPH, MBA
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 10800 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-3043
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Country | US
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Telephone | 951-353-4047
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Fax | 951-353-3099
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Provider Business Mailing Address
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Address Line | 11080 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-3047
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Country | US
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Telephone | 951-602-4114
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Fax | 951-602-4128
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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 | 45695
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License Number State | CA
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