Provider Demographics
NPI:1043861313
Name:TRIAS, MARY GRACE P (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:P
Last Name:TRIAS
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31485 MANDY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-5124
Mailing Address - Country:US
Mailing Address - Phone:951-459-9017
Mailing Address - Fax:951-245-8862
Practice Address - Street 1:31485 MANDY CT
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-5124
Practice Address - Country:US
Practice Address - Phone:951-459-9017
Practice Address - Fax:951-245-8862
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6048231740376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator