Provider Demographics
NPI:1568762615
Name:CHA, MAURISA S (MAURISA CHA)
Entity Type:Individual
Prefix:DR
First Name:MAURISA
Middle Name:S
Last Name:CHA
Suffix:
Gender:F
Credentials:MAURISA CHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 CONTRA COSTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3306
Mailing Address - Country:US
Mailing Address - Phone:925-688-0684
Mailing Address - Fax:925-688-0688
Practice Address - Street 1:1978 CONTRA COSTA BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3306
Practice Address - Country:US
Practice Address - Phone:925-688-0684
Practice Address - Fax:925-688-0688
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist