Provider Demographics
NPI:1639954902
Name:ABACAN, DARA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:
Last Name:ABACAN
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 1:4752 AMBERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1909
Mailing Address - Country:US
Mailing Address - Phone:562-841-8284
Mailing Address - Fax:
Practice Address - Street 1:415 N OAK ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-3314
Practice Address - Country:US
Practice Address - Phone:310-671-2600
Practice Address - Fax:310-671-2601
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA635381835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations