Provider Demographics
NPI:1578189551
Name:FEGAN, JUSTINE ROMELIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:ROMELIA
Last Name:FEGAN
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 1:3260 AVENIDA DE LOYOLA
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3225
Mailing Address - Country:US
Mailing Address - Phone:760-579-9437
Mailing Address - Fax:
Practice Address - Street 1:1980 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5939
Practice Address - Country:US
Practice Address - Phone:760-945-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist