Provider Demographics
NPI:1659740082
Name:COLADA, CZARINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CZARINA
Middle Name:
Last Name:COLADA
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 1:12429 HARWICK DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1873
Mailing Address - Country:US
Mailing Address - Phone:909-702-2394
Mailing Address - Fax:
Practice Address - Street 1:16964 SLOVER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7556
Practice Address - Country:US
Practice Address - Phone:909-356-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73335183500000X
NV19084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist