Provider Demographics
NPI:1134673809
Name:GUILLERMO, MARICELA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARICELA
Middle Name:
Last Name:GUILLERMO
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 1:257 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-4130
Mailing Address - Country:US
Mailing Address - Phone:626-449-0099
Mailing Address - Fax:
Practice Address - Street 1:257 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4130
Practice Address - Country:US
Practice Address - Phone:626-449-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469981835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care