Provider Demographics
NPI:1578845145
Name:MULALA-SIMPSON, LISELI I (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISELI
Middle Name:I
Last Name:MULALA-SIMPSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 VALENCIA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4423
Mailing Address - Country:US
Mailing Address - Phone:415-970-8001
Mailing Address - Fax:415-970-8005
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4423
Practice Address - Country:US
Practice Address - Phone:415-970-8001
Practice Address - Fax:415-970-8005
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH54290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA485790Medicaid