Provider Demographics
NPI:1164685681
Name:DIMALANTA, MAYBELLENE MAGALUED (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAYBELLENE
Middle Name:MAGALUED
Last Name:DIMALANTA
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 1:292 WILLIAM WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4779
Mailing Address - Country:US
Mailing Address - Phone:925-550-5738
Mailing Address - Fax:
Practice Address - Street 1:292 WILLIAM WAY
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4779
Practice Address - Country:US
Practice Address - Phone:925-550-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist