Provider Demographics
NPI:1396188314
Name:CEBALLOS, OLIVIA MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MARIE
Last Name:CEBALLOS
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 1:416 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3332
Mailing Address - Country:US
Mailing Address - Phone:559-791-0104
Mailing Address - Fax:559-791-0117
Practice Address - Street 1:416 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3332
Practice Address - Country:US
Practice Address - Phone:559-791-0104
Practice Address - Fax:559-791-0117
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist