Provider Demographics
NPI:1164831129
Name:WORLIKAR, MANGALA
Entity Type:Individual
Prefix:
First Name:MANGALA
Middle Name:
Last Name:WORLIKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34220 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2096
Mailing Address - Country:US
Mailing Address - Phone:760-770-9622
Mailing Address - Fax:760-770-8853
Practice Address - Street 1:34220 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2096
Practice Address - Country:US
Practice Address - Phone:760-770-9622
Practice Address - Fax:760-770-8853
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist