Provider Demographics
NPI:1659690584
Name:RECIO, ADDIE SOLLANO (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:ADDIE
Middle Name:SOLLANO
Last Name:RECIO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 230TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4825
Mailing Address - Country:US
Mailing Address - Phone:310-518-3699
Mailing Address - Fax:
Practice Address - Street 1:11340 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2807
Practice Address - Country:US
Practice Address - Phone:323-757-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist