Provider Demographics
NPI:1821509498
Name:RIZKALLA, MARINA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:M
Last Name:RIZKALLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:M
Other - Last Name:RIZKALLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:29756 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-4525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1902
Practice Address - Country:US
Practice Address - Phone:317-338-5818
Practice Address - Fax:317-338-4394
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027374A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist