Provider Demographics
NPI:1497265755
Name:DEWOSKIN, MARK ROBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ROBERT
Last Name:DEWOSKIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 MEURICE CIR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9454
Mailing Address - Country:US
Mailing Address - Phone:951-310-9502
Mailing Address - Fax:
Practice Address - Street 1:7261 MEURICE CIR
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-9454
Practice Address - Country:US
Practice Address - Phone:951-310-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-01
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist