Provider Demographics
NPI:1114373248
Name:MAMARIL, CARISSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARISSE
Middle Name:
Last Name:MAMARIL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10706 VICTORY BLVD APT 213
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3859
Mailing Address - Country:US
Mailing Address - Phone:818-384-4058
Mailing Address - Fax:
Practice Address - Street 1:1050 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2102
Practice Address - Country:US
Practice Address - Phone:213-975-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist