Provider Demographics
NPI:1518731223
Name:RIZKALLAH, MARINA M (IR)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:M
Last Name:RIZKALLAH
Suffix:
Gender:F
Credentials:IR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 E MAIN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3136
Mailing Address - Country:US
Mailing Address - Phone:949-275-6707
Mailing Address - Fax:
Practice Address - Street 1:1323 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3136
Practice Address - Country:US
Practice Address - Phone:253-848-3564
Practice Address - Fax:253-770-9187
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR61399784183500000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183500000XPharmacy Service ProvidersPharmacist