Provider Demographics
NPI:1588005110
Name:DEGUZMAN, MYLENE MANALO (PHARMD, BCPS, APH)
Entity Type:Individual
Prefix:
First Name:MYLENE
Middle Name:MANALO
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:PHARMD, BCPS, APH
Other - Prefix:
Other - First Name:MYLENE
Other - Middle Name:
Other - Last Name:MANALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCPS
Mailing Address - Street 1:4918 S TANGERINE WAY
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-7292
Mailing Address - Country:US
Mailing Address - Phone:562-818-1103
Mailing Address - Fax:
Practice Address - Street 1:8510 BALBOA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5810
Practice Address - Country:US
Practice Address - Phone:818-810-4600
Practice Address - Fax:818-933-0516
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH65899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist