Provider Demographics
NPI:1376923458
Name:CASTILLO, SHIRLEY FONDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:FONDA
Last Name:CASTILLO
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 1:2377 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3347
Mailing Address - Country:US
Mailing Address - Phone:800-766-0122
Mailing Address - Fax:
Practice Address - Street 1:2377 CRENSHAW BLVD
Practice Address - Street 2:SUITE 155
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3347
Practice Address - Country:US
Practice Address - Phone:800-766-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist