MEDICARE: PAULINE MONIQUE A MALLARI PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	79850	CA

General Provider Information

NPI Number	:	1528680881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE MONIQUE A MALLARI PHARMD

Provider Business Mailing Address
First Line	:	857 E TAM O SHANTER ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-8713
Country	:	US
Telephone Number	:	909-938-5631
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 S EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-6519
Country	:	US
Telephone Number	:	909-984-0140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2020
Last Update Date	:	05/09/2020

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