Provider Demographics
NPI:1629289236
Name:JAMBUSARIA, RUPA MAULIK (MASTER OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:MAULIK
Last Name:JAMBUSARIA
Suffix:
Gender:F
Credentials:MASTER OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 SKYLER WAY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2358
Mailing Address - Country:US
Mailing Address - Phone:714-255-9337
Mailing Address - Fax:
Practice Address - Street 1:6360 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4102
Practice Address - Country:US
Practice Address - Phone:323-585-4321
Practice Address - Fax:323-585-0161
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH50097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist