Provider Demographics
NPI:1790239234
Name:DEGUZMAN, REBECCA MANALAC (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MANALAC
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:REBECCA
Other - Last Name:DEGUZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3847
Mailing Address - Country:US
Mailing Address - Phone:909-982-8908
Mailing Address - Fax:909-931-0900
Practice Address - Street 1:100 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3847
Practice Address - Country:US
Practice Address - Phone:909-982-8908
Practice Address - Fax:909-931-0900
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-13
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist