Provider Demographics
NPI:1477926269
Name:MOHIUDDIN, ROSALYN DELACRUZ (RPH, PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:DELACRUZ
Last Name:MOHIUDDIN
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 MISSION CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4328
Mailing Address - Country:US
Mailing Address - Phone:619-298-3655
Mailing Address - Fax:619-298-6050
Practice Address - Street 1:5644 MISSION CENTER RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4328
Practice Address - Country:US
Practice Address - Phone:619-298-3655
Practice Address - Fax:619-298-6050
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist