Provider Demographics
NPI:1194025478
Name:HSIEH, MARY C (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:HSIEH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHING-FAN
Other - Last Name:HSIEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 PORTOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0833
Mailing Address - Country:US
Mailing Address - Phone:949-544-3236
Mailing Address - Fax:949-544-3365
Practice Address - Street 1:3901 PORTOLA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0833
Practice Address - Country:US
Practice Address - Phone:949-544-3236
Practice Address - Fax:949-544-3365
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist