Provider Demographics
NPI:1720388804
Name:WIJONO, MARIKA (RPH)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:
Last Name:WIJONO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1302
Mailing Address - Country:US
Mailing Address - Phone:650-949-2840
Mailing Address - Fax:650-949-0736
Practice Address - Street 1:2580 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1302
Practice Address - Country:US
Practice Address - Phone:650-949-2840
Practice Address - Fax:650-949-0736
Is Sole Proprietor?:No
Enumeration Date:2010-10-24
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist