Provider Demographics
NPI:1285010918
Name:ASHAMALLA, MARIANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:ASHAMALLA
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 1:27102 SILVER OAK LN APT 1021
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-6399
Mailing Address - Country:US
Mailing Address - Phone:732-692-7093
Mailing Address - Fax:
Practice Address - Street 1:2419 E AVENUE S
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6202
Practice Address - Country:US
Practice Address - Phone:661-274-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist