Provider Demographics
NPI:1073521126
Name:MARSHALL, IRENE YAMAGA (PHARMD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:YAMAGA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:YAMAGA
Other - Last Name:TAMAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:PHARMACY (119)
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-268-3408
Mailing Address - Fax:310-268-4959
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:PHARMACY (119)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-3408
Practice Address - Fax:310-268-4959
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381751835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy