Provider Demographics
NPI:1578987202
Name:PHUA, MARITESS M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARITESS
Middle Name:M
Last Name:PHUA
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 1:3315 S H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-6533
Mailing Address - Country:US
Mailing Address - Phone:661-396-0634
Mailing Address - Fax:661-396-0280
Practice Address - Street 1:3315 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-6533
Practice Address - Country:US
Practice Address - Phone:661-396-0634
Practice Address - Fax:661-396-0280
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist